Surgical Treatment of Amplatzer Embolus in a Secundum Atrial Septal Defect Patient
A 38-year-old, 160 cm tall, 65 kg woman was referred to our hospital with the diagnosis of the secundum ASD. She had initially referred to another hospital with the complaints of palpitation and shortness of breath. During cardiologic evaluation, echocardiography was performed and a secundum type ASD (pulmonary to systemic blood flow ratio [Qp/Qs]: 2.0), first to second degree mitral regurgitation, and first to second degree tricuspid regurgitation were noted. There was a mild increase in the right ventricular dimensions. Pulmonary artery pressure was measured as 45 mm Hg. In our hospital, echocardiography was performed again and the anatomy was found suitable for the implantation of an ASD occluder device. During catheter closure, the occluder device was embolized. The patient was heparinized for systemic anticoagulation. It was not possible to retrieve the embolized device via catheterization procedures, and the patient was referred for emergency surgical removal. Surgical intervention was performed within forty-five minutes of embolization. The electrocardiogram was normal sinus rhythm. On chest X-ray, the ‘Amplatzer occluder Device’ was seen in the right pulmonary artery localization ().\nThe patient underwent surgery under general anesthesia and with standard median sternotomy incision. There were pericardial adhesions. Once the pericardium had been opened, the ‘Amplatzer Occluder Device’ was easily palpated in the right pulmonary artery proximal to the superior vena cava. Cardiopulmonary bypass (CPB) under moderate hypothermia was established with aorto-bicaval cannulation (selective superior vena cava cannulation was performed). Myocardial management was provided by antegrade cold and terminal warm blood cardioplegia. Right atriotomy was performed. A 2.5 × 1.5 cm secundum type ASD was seen. It was closed with a Teflon patch. Right pulmonary arteriotomy was performed proximal to the superior vena cava and the device was removed ( and ). Arteriotomy was closed primarily. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day.