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Published on: February 28, 2012
Retrieval and repositioning of an embolized atrial septal defect closure device using a gooseneck snare
Akash Batta1, Sanjeev Naganur1, Ajay Rajan1
1Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Insights
A gooseneck snare successfully retrieved and repositioned an embolized atrial septal defect (ASD) closure device in a child, avoiding surgery. This case highlights the gooseneck snare
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Percutaneous device closure is a preferred alternative to surgery for atrial septal defects (ASDs).
- Device embolization is a rare but significant complication of percutaneous ASD closure.
- Prompt management is crucial for successful outcomes in device embolization cases.
Purpose of the Study:
- To report a case of spontaneous embolization of an ASD closure device.
- To describe the successful retrieval and deployment of an embolized device using a gooseneck snare.
- To emphasize the utility of the gooseneck snare in managing device embolization.
Main Methods:
- A 5-year-old child with an 18-mm ostium secundum ASD underwent percutaneous closure.
- The 20-mm ASD closure device spontaneously embolized into the left atrium prior to deployment.
- A 20-mm gooseneck snare was used to retrieve and reposition the embolized device across the ASD.
Main Results:
- The embolized ASD closure device was successfully snared and repositioned.
- The device was deployed across the atrial septal defect under fluoroscopic and echocardiographic guidance.
- The child remained hemodynamically stable and was discharged 2 days post-procedure.
Conclusions:
- The gooseneck snare is an effective tool for managing embolized ASD closure devices.
- Successful repositioning and deployment of an embolized device can obviate the need for emergency surgery.
- This case demonstrates a valuable approach to a challenging complication in device closure of ASDs.
Background:
Closure of all haemodynamically significant atrial septal defects (ASDs) is recommended irrespective of symptoms. Percutaneous device closure offers a favourable alternative to surgery with lower morbidity, shorter duration of hospital stays, and avoidance of a surgical scar. Though device closure is generally a safe procedure with high success rates, certain complications can arise including device embolization which poses a significant challenge for the treating team. We report one such case in which the ASD closure device got spontaneously released and embolized from the delivery cable into the left atrium prior to its deployment. We describe our approach for its retrieval and subsequently its successful deployment across the septal defect using a gooseneck snare.
Case Presentation:
A 5-year-old asymptomatic child was found to have a murmur on a routine check-up. Evaluation revealed a haemodynamically significant, 18-mm ostium secundum ASD with normal pulmonary pressures and suitable margins for device closure. A 20-mm ASD closure device was traversed via an 8-Fr delivery system. While manipulating the left atrial (LA) disc from the right upper pulmonary vein (RUPV) approach, the device got spontaneously released. The right atrial (RA) disc was caught across the ASD, into the left atrium. This was confirmed by intraoperative transthoracic echocardiography and fluoroscopy. The haemodynamics and rhythm were stable. A 20-mm gooseneck snare was immediately passed through the delivery sheath and an attempt was made to catch the screw. With difficulty, the RA screw was caught with the snare and multiple attempts to retrieve the device into the sheath were unsuccessful. However, while negotiating, we were able to secure a favourable position of the device across the atrial septal defect, and after fluoroscopic and echocardiographic confirmation, the device was released. The child remained stable thereafter and was discharged 2 days later.
Conclusions:
Gooseneck snare is a valuable tool in the management of embolized ASD closure device. Occasionally, like in the index case, one may be successful in retrieving the embolized device and repositioning it across the ASD using a gooseneck snare, thus obviating the need for emergency surgery.
