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Surgical Removal of Embolized Ventricular Septal Occluder Device
Nikunj Vaidhya1, Amit Mishra2, Sumbul Siddiqui1
11 Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India.
Insights
Device embolization during transcatheter closure of ventricular septal defect (VSD) with pulmonary stenosis (PS) is a rare complication. This case highlights the importance of precautions and successful retrieval of an embolized VSD device.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Ventricular septal defect (VSD) with valvar pulmonary stenosis (PS) is a complex congenital heart defect.
- Percutaneous catheter-directed interventions are considered for treating combined VSD and PS.
- Device embolization is a rare but serious complication of transcatheter septal defect closure.
Observation:
- A five-year-old patient with perimembranous VSD and valvar PS with infundibular hypertrophy underwent balloon pulmonary valvotomy and VSD closure.
- A catheter-directed duct occluder device was used for VSD closure.
- The VSD occluder device embolized to the aortic arch shortly after deployment.
Findings:
- Embolization may be linked to dynamic contractions of hypertrophied muscle in the right ventricular outflow tract, potentially dislodging single-disc devices.
- The embolized device was successfully retrieved.
- Retrieval required cardiopulmonary bypass and circulatory arrest.
Implications:
- Highlights the potential risk of device embolization in complex VSD/PS cases.
- Emphasizes the need for careful patient selection and procedural precautions.
- Demonstrates the feasibility of device retrieval in cases of embolization.
Abstract:
Ventricular septal defect (VSD) with valvar pulmonary stenosis (PS) is a combination of cardiac defects for which treatment by means of percutaneous catheter-directed intervention is sometimes considered. Septal occluder device embolization is a rare but potentially dreadful complication. Adequate precautions are of great importance, as operator-related and anatomical factors can contribute to the risk of device embolization. In this report, we present a case of a five-year-old patient with a perimembranous VSD and valvar PS with infundibular muscle hypertrophy. The PS was treated with balloon pulmonary valvotomy, and the VSD was closed with a catheter-directed duct occluder device. Soon after deployment, the device embolized to the aortic arch, possibly as a result of the single disc device being "milked" out of VSD by dynamic contractions of hypertrophied muscle in the right ventricular outflow tract. The embolized device was successfully retrieved and removed using cardiopulmonary bypass and a period of circulatory arrest.
