case_images: PMC10611486_01
case_images: Secundum-type ASD finding and percutaneous secundum-type ASD closure. Transthoracic echocardiography revealed about 22 mm ASD (white arrow) with shunt flow from left atrium to right atrium (A) The intraoperative fluoroscopy showed that the guidewire passed through the inferior vena cava and the right atrium sequentially, and then through the defect site to the left atrium (B); a 24 mm ASO device was successfully deployed in the ASD (C).
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case_images: PMC10611486_01_fcvm-10-1269032-g001.jpg
case_images: F1
case_images: Local transthoracic echocardiography demonstrated a delicate and weak area measuring approximately 22 mm in the middle of the atrial septum, exhibiting movement synchronized with the cardiac cycle and abnormal left-to-right shunt flow, along with mild dilation of the right ventricle and atrium (Figure 1A). The intraoperative fluoroscopy confirmed the findings, as the guidewire sequentially passed through the inferior vena cava, right atrium, and defect site to the left atrium (Figure 1B). The position of the occluder device was optimal, with no residual shunt observed on fluoroscopic examination after the final release (Figure 1C, arrow).
case_images: The ASO device embolization. Transthoracic echocardiography showing no occluder device and an interrupted echo (white arrow) in the middle of the atrial septum associated with a large number of left to right shunt flow (A); The lateral chest x-ray showed that the embolized occluder was located in the descending aorta (white arrow) (B); The chest CT showed that the embolized occluder device (white arrow) was located at the descending thoracic aortic isthmus (transverse view, C), (coronal view, D).
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case_images: F2
case_images: However, two days after implantation, a heart murmur reemerged, and immediate transthoracic echocardiography revealed no occluder device in the middle of the atrial septum, accompanied by a significant left-to-right shunt flow (Figure 2A). Chest x-ray indicated that the occluder was located in the descending aorta (Figure 2B). Computed tomography of the chest and abdomen confirmed the embolization of the occluder device to the descending thoracic aortic isthmus, with no evidence of vascular dissection, extravasation, or limb ischemia (Figures 2C,D).
case_images: Percutaneous retrieval of the ASO device. Fluoroscopy revealed the embolized ASO device in the descending thoracic aortic isthmus (A); an Amplatz Goose Neck snare was advanced to the near occluder (B); after successful snaring of the screw on right atrial disc of ASO device (C), ASO device was successfully retrieved into the 12-French vascular sheath (D).
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case_images: F3
case_images: Since transthoracic echocardiography revealed no significant abnormalities in the anatomy and function of the mitral and aortic valves, and there were no significant hemodynamic changes, the patient underwent percutaneous retrieval of the embolized occluder device and subsequent redeployment under local anesthesia (Figure 3). Chest fluoroscopy confirmed the embolization of the occluder device to the descending thoracic aortic isthmus (Figure 3A). Using a 12-French vascular sheath inserted through the right femoral artery, an Amplatz Goose Neck snare kit device was advanced to the embolized site (Figure 3B). The pedicle of the occluder was exposed by adjusting its position, allowing successful capture by the Amplatz Goose Neck snare under fluoroscopic guidance (Figure 3C). The displaced occluder was pulled into the vessel sheath (Figure 3D) and ultimately removed from the body through the puncture site in the right femoral artery.
case_images: Percutaneous redeployment of the ASO device. Fluoroscopy revealed the 26 mm occluder was sent into the left atrium and the two sides of the occluder were successfully deployed on both sides of the defect (A); the position and shape of the redeployed occluder (white arrow) were found to be optimum, and no residual shunt (B) The occluder was located in the middle of the atrial septum (C) with no residual shunt (D) during the follow-up period.
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case_images: F4
case_images: Subsequently, a 26 mm occluder was advanced into the left atrium using the long vascular sheath, and both sides of the occluder were successfully deployed on either side of the defect (Figure 4A). Chest fluoroscopy confirmed the optimal position and shape of the redeployed occluder, with no residual shunt (Figure 4B). During one month of clinical follow-up, the patient did not experience any cardiac symptoms or events, and transthoracic echocardiography confirmed the appropriate position of the occluder in the middle of the atrial septum, with no residual shunt (Figures 4C,D).