Incomplete Endothelialization and Late Dislocation After Implantation of an Amplatzer Septal Occluder Device

Abstract

A 64-year-old woman with a history of a large-sized secundum atrial septal defect (ASD) underwent successful percutaneous closure with a 34-mm Amplatzer septal occluder (ASO) without apparent complications on April 25, 2002. Transthoracic echocardiography immediately following the closing procedure revealed that her ASO was well wedged, with no residual shunt or murmurs (Figure 1). At the third year of follow-up, a small volume of split flow was detected by transthoracic echocardiography. No intervention was attempted at that time because the shunt was not clinically significant and the patient had no uncomfortable symptoms. However, at the last follow-up visit in 2009, the patient had a chest distress and palpitation after daily activity; transthoracic echocardiography showed that the ASO was dislodged into the left atrium and that only a part of the ASO remained at the defect border (Figure 2). Figure 1. Transthoracic echocardiography (subcostal 2 atrial view) shows the exact position …