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Retrieval of patent ductus arteriosus device embolization using hybrid approach: a case report
Uma Devi Karuru1, Sadanand Reddy Tummala1, T Naveen2
1Department of Cardiology, ESIC Medical College and Super Speciality Hospital, Room no 107, 1 st floor, Sanath Nagar, Hyderabad, 500038, India.
Insights
Device embolization during patent ductus arteriosus (PDA) closure is rare. A case of Amplatzer duct occluder embolization into the aorta was successfully managed with combined surgical and percutaneous techniques.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Patent ductus arteriosus (PDA) closure is crucial to prevent heart failure and pulmonary hypertension.
- Catheter-based closure with devices like the Amplatzer duct occluder is preferred but carries risks.
- Device embolization is a rare complication, especially in pediatric patients.
Purpose of the Study:
- To report a complex case of spontaneous embolization of a PDA closure device.
- To highlight the management of device embolization in a pediatric patient.
- To emphasize the importance of multidisciplinary approaches in managing rare complications.
Main Methods:
- A case report of an 11-month-old female with PDA closure device embolization to the descending aorta.
- Initial percutaneous retrieval attempts using a snare were unsuccessful.
- Emergency surgical exploration and device retrieval were performed.
Main Results:
- The Amplatzer Duct Occluder I device embolized into the descending aorta and lodged in the left common iliac artery.
- Percutaneous retrieval was abandoned due to risk of arterial dissection.
- Successful surgical retrieval of the device was achieved without complications.
- The patient recovered well with improved limb perfusion and was discharged.
Conclusions:
- Meticulous planning and adaptive decision-making are vital for managing rare PDA device closure complications.
- A combined percutaneous and surgical approach can effectively manage device embolization.
- Successful management of this rare complication underscores the value of multidisciplinary collaboration in pediatric cardiology.
Background:
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.
Case Presentation:
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.
Conclusions:
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.
