Surgical Extraction of an Embolized Atrial Septal Defect Occluder Device into Pulmonary Artery after Percutaneous Closure
A 22 years old female patient was admitted to our outpatient clinic with a complaint of dyspnea for the previous three years. Her physical examination revealed a 1-2/6 pansystolic murmur in the mesocardiac area. A right bundle branch block was detected on her electrocardiogram. In the transthorasic echocardiography (TTE), a 22 mm secundum type atrial septal defect (ASD), right heart dilatation and pulmonary arterial hypertension (PAP 45 mmHg) were detected. Transesophageal echocardiography (TEE) showed that the defect was 25 mm, the superior rim was 16 mm and the aortic rim was 8 mm in size. The defect was closed through a right femoral route with a 30 mm ASD occluder after balloon sizing with TTE. In the cineangiography and TTE early after the procedure, the device was observed to be in the correct position (). The patient had experienced dyspnea one hour after the procedure. The TTE revealed that the device was not in the defect and it had embolized to the pulmonary artery. The patient was referred to the cardiovascular surgery unit and underwent surgery promptly. Under general anaesthesia, a median sternotomy was done. The pericardium was opened with an aortobicaval cannulation under cardio-pulmonary bypass. The pulmonary artery was incised along its vertical axis and the occluder device was removed (). The right atrium was opened and the defect was then closed with a pericardial patch. The patch was patent by the first postoperative day as shown on control echocardiography.