Hybrid Transcatheter and Endoscopic Retrieval of a Pulmonary Artery-Embolized ASD Occluder in Hemodynamic Compromise

Embolization of atrial septal defect (ASD) occluders is uncommon but potentially life-threatening, often requiring urgent intervention. Transcatheter retrieval is typically attempted first, but success depends on achieving slenderizing of the device-which may be limited by anatomy or device position, frequently necessitating surgical removal.

A 25-year-old woman presented with hemodynamic compromise after embolization of an ASD occluder into the main pulmonary artery. A tailored hybrid strategy was undertaken: controlled snare-guided mobilization of the device into the right ventricle created a surgically accessible position, enabling minimally invasive 3D-endoscopic extraction and definitive ASD repair, avoiding sternotomy and pulmonary arteriotomy.

This case represents the first reported hybrid combination of transcatheter approach with minimally invasive endoscopic cardiac surgery for pulmonary artery-embolized ASD occluder retrieval, highlighting the importance of interdisciplinary, cross-subspecialty procedural planning.

Hybrid transcatheter-endoscopic approaches may be a feasible, least-invasive retrieval and repair strategy when standalone transcatheter retrieval is unsuccessful.