Atrial septal defect occluder device embolization: Experience of a tertiary care cardiac center
Sandeep Garre1, Shrinivas Gadhinglajkar2, Rupa Sreedhar2
1Department of Anaesthesiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India.
Insights
Device embolization during atrial septal defect (ASD) closure is a rare but serious complication. This study analyzes risk factors and outcomes of ASD device embolization, highlighting retrieval methods and potential complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous device closure for atrial septal defect (ASD) is increasingly common.
- Device embolization is a rare but life-threatening complication of ASD closure.
Purpose of the Study:
- To analyze risk factors for device embolization.
- To identify common embolization sites and associated complications.
- To evaluate treatment strategies for embolized devices.
Main Methods:
- Retrospective analysis of patients with embolized ASD devices at a tertiary referral center.
- Data collected on pre-procedure, intra-procedure, and post-procedure events.
- Analysis of risk factors, embolization sites, complications, timing, and treatment.
Main Results:
- Thirty devices embolized; 13 retrieved percutaneously, 17 surgically.
- Unfavorable septal morphology noted in 14 patients.
- Devices embolized to various heart chambers and great vessels; rare complications included IVC tear and air embolism.
Conclusions:
- Device embolization significantly increases procedural risks.
- Surgical retrieval may require complex interventions like circulatory arrest.
- Fatal air embolism is a rare but possible outcome.
Background:
Percutaneous device closure of atrial septal defect (ASD) has become an increasingly popular procedure as it offers several advantages. However, it is associated with infrequent, but life-threatening complications such as device embolization.
Objective:
To analyze the risk factors, common sites of embolization, associated complications, timing of embolization, and the treatment executed.
Settings And Design:
A retrospective study was performed at a tertiary referral center for cardiac services.
Material And Methods:
Pre-procedure, intra-procedure, and post-procedure data of patients whose ASD device embolized was collected retrospectively and analyzed for risk factors, common sites of embolization, associated complications, timing of embolization, and the treatment executed. Results: Thirty devices were embolized, out of which 13 were retrieved percutaneously in the Catheter laboratory, whereas 17 patients underwent surgery. Fourteen patients had an unfavorable septal morphology for device closure. Ten devices were embolized in the catheter laboratory, five in the intensive care unit, and two in the ward. The devices were embolized to almost all chambers of the heart and great vessels. One patient had an inferior vena cava rim tear while attempting percutaneous retrieval. One patient required a short period of total circulatory arrest (TCA) for retrieval of the device from ascending aorta, while another required a lateral position for retrieval from descending aorta. One patient required re-exploration for bleeding, while another had an air embolism and succumbed.
Conclusions:
Once embolization occurs, the risks associated increase manifold. Most of the surgical extractions are uneventful; however, there could be certain complications that may need repair of valvular apparatus, the institution of TCA, or the need for the lateral position. Air embolization though very rare can occur which could be fatal.
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