Retrieval of patent ductus arteriosus device embolization using hybrid approach: a case report

Patent ductus arteriosus (PDA) is a congenital heart defect that requires closure to prevent complications like heart failure and pulmonary hypertension. Catheter-based closure using devices such as the Amplatzer duct occluder is the preferred method due to its minimally invasive nature. However, device embolization is a rare but recognized complication, particularly in small children or high-flow PDAs.

We report a rare and complex case of spontaneous embolization of a PDA closure device into the descending aorta in an 11-month-old female. The patient, with a history of recurrent lower respiratory tract infections and poor weight gain, underwent a PDA closure procedure after a thorough assessment. During the procedure, the Amplatzer Duct Occluder I device unexpectedly migrated into the descending aorta. Despite initial attempts at percutaneous retrieval using a goose neck snare, the device lodged in the left common iliac artery due to size discrepancy. Further snaring was abandoned to prevent the risk of artery dissection. The patient was then taken for emergency surgical exploration. The cardiovascular surgical team successfully retrieved the device through a left supra-inguinal incision, with no complications post-surgery. The patient showed improved limb perfusion and was discharged one week later.

This case underscores the importance of meticulous procedural planning, multidisciplinary collaboration, and adaptive decision-making in managing rare and challenging complications during PDA device closure. The successful outcome, despite the complex nature of the complication, highlights the effectiveness of combining percutaneous and surgical approaches in pediatric cardiology.