Related Experiment Video
Updated: Dec 18, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Not just another large atrial septal defect: complex anatomy, challenging procedure, and an unusual complication
Raymond N Haddad1, Tony Abdel Massih2, Zakhia Saliba3
1Hotel Dieu de France University Medical Center, Department of Pediatrics, Saint Joseph University, Beirut, Lebanon.
Insights
A patient with a complex atrial septal defect experienced pericardial effusion after Amplatzer septal occluder implantation. Despite initial resolution, effusion recurred, leading to device explantation, highlighting diagnostic challenges.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Device Technology
Background:
- Atrial septal defects (ASDs) are commonly treated with device closure.
- Amplatzer septal occluders are widely used for ASD repair.
- Pericardial effusion is a rare but serious complication following device implantation.
Observation:
- A 59-year-old patient with a complex ASD underwent implantation of a 40-mm Amplatzer septal occluder.
- Initial challenging deployment led to pericardial effusion, managed conservatively.
- Recurrent pericardial effusion with contrast enhancement prompted surgical explantation.
Findings:
- The explanted Amplatzer device was well-positioned with an intact pericardium.
- Atypical clinical presentation complicated the diagnosis and management.
- Surgical intervention was based on imaging findings suggestive of effusion recurrence.
Implications:
- This case underscores the importance of considering atypical presentations of device-related complications.
- Careful clinical correlation with imaging is crucial for accurate diagnosis.
- Understanding such rare events can refine management protocols for septal occluder implantation.
Abstract:
We report the case of a 59-year-old patient with a complex atrial septal defect in whom a 40-mm Amplatzer™ septal occluder was surgically extracted 50 days following implantation. Deployment manoeuvres were challenging leading to an immediate pericardial effusion that was closely monitored and uneventfully drained after 11 days. A dry pericardium was documented until 4 weeks of outpatient routine follow-up. However, the device was surgically explanted 2 weeks later, when an urgent chest computed tomography performed for worrisome symptoms showed pericardial effusion recurrence with peripheral contrast enhancement. Surprisingly, the surgical view showed a well-positioned device and an intact pericardium. We discuss the atypical sequence of clinical findings misleading our clinical judgement and precipitating surgery.
