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Urgent surgical management for embolized occluder devices in childhood: single center experience
Gokhan Gokaslan1, Hasim Ustunsoy, Hayati Deniz
1Department of Cardiovascular Surgery, Gaziantep University Medical Faculty, Gaziantep, Sehitkamil 27310, Turkey. cerrah06@yahoo.com
Insights
Urgent surgery effectively removed embolized cardiac devices in children following trans-catheter closure procedures. Surgical management ensures successful outcomes when percutaneous retrieval fails, highlighting the need for planned strategies.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Trans-catheter closure of congenital heart defects can lead to device embolization.
- Device embolization is a significant complication requiring urgent intervention.
- This study analyzes surgical management of embolized cardiac occluders in children.
Purpose of the Study:
- To analyze the experience with urgent surgical management of embolized cardiac septal and ductal occluder devices.
- To discuss risk factors and surgical techniques for device removal in pediatric patients.
Main Methods:
- Retrospective review of 9 pediatric patients (aged 2-15 years) undergoing urgent surgery for device embolization.
- Analysis of congenital defects including atrial septal defect, ventricular septal defect, and patent ductus arteriosus.
- Evaluation of surgical techniques for embolized device removal and defect repair.
Main Results:
- Successful removal of embolized devices in all 9 patients.
- Tricuspid valve repair in 2 patients.
- No hospital mortality or morbidity observed, with all operations completed successfully.
Conclusions:
- Device embolization remains a major complication of percutaneous closure for left-to-right shunting defects.
- Surgical management is the definitive treatment when percutaneous retrieval fails.
- Well-planned urgent management strategies are crucial for uneventful perioperative outcomes.
Background:
In this study, we sought to analyze our experience in urgent surgical management for embolized cardiac septal and ductal occluder devices resulting from trans-catheter closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus in childhood patient group.
Methods:
We retrospectively reviewed 9 patients (aged 2-15 years) who underwent urgent surgery due to cardiac septal and ductal occluder embolization between January 2007 and December 2010. Congenital defects were atrial septal defect (n = 6), ventricular septal defect (n = 1), and patent ductus arteriosus (n = 2). Risk factors for device embolization and urgent surgical management techniques for embolized device removal were discussed.
Results:
Removal of embolized devices in all cases and repair of damaged tricuspid valve in 2 patients were performed. Inevitably, all congenital defects were closed or ligated up to the primary defect. Total circulator arrest necessitated in 1 patient with ascending aortic device embolization. All operations were completed successfully and no hospital mortality or morbidity was encountered.
Conclusions:
Although closure of left to right shunting defects by percutaneous occluder devices has a lot of advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.
