Abstract
A 66-year-old male with a history of percutaneously closed atrial septal defect (ASD) with a Cera™ occluder four years earlier underwent transthoracic echocardiography. Device migration into the left ventricular outflow tract and moderate mitral regurgitation (MR) were found (Panel A). The previous follow-up 12 months echocardiogram was unremarkable. Periprocedural imaging showed a 30 × 17 mm ASD, a borderline anterior rim (5 mm), and a thin posterior rim, considered adequate according to current guidelines. The expanded balloon diameter was 31 mm and a 36 device was selected. During the procedure final device position was satisfactory and the device was stable after the tug test. After the heart team reviewed the case interventional retrieval of the device was attempted. Using a snare catheter and a double tool retrieval technique, the attempts were unsuccessful (Panel E). The patient was sent for cardiac surgery. Pre-operative transoesophageal echocardiogram showed entrapment of the device in the mitral subvalvular apparatus and chordae tendineae rupture causing eccentric severe MR (Panel B, C, and D). Surgical removal of the device (Panel F), ASD closure, and mitral valve replacement were performed.
Published Version
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