Percutaneous Removal of an Embolized Atrial Septal Defect Device With a Novel Retrieval System

Figures

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  Figure 1. Multimodality Imaging Before Device Retrieval (A) Intracardiac echocardiography after deployment of the 44-mm GORE CARDIOFORM ASD Occluder in the atrial septum. (B) Four-hour postprocedure chest radiography (CXR) (white arrow). (C) CXR at the time of nausea and vomiting showing stable device positioning (white arrow). (D) CXR after hypotension and hypoxia demonstrating device embolization (red arrow). (E and F) Axial and coronal computed tomography imaging with a device (and associated thrombus) in the right pulmonary artery (RPA) (red arrows). The left pulmonary artery is unobstructed, and there is flow around the device to the distal RPA branches.

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  Figure 2. Intraprocedural Fluoroscopic Imaging and Device Extraction Step-by-step obtained fluoroscopic images of device retrieval into the ŌNŌ retrieval system. (A) Snaring of the device pin using a 10-mm Amplatz Goose Neck snare and a 4-F Judkins Left 3.5 catheter (white arrow). (B) Pulling the device into the ŌNŌ retrieval basket, with the device locking loop intact (red arrow). (C) Unlocking and elongation of the device into the ŌNŌ retrieval basket (white arrowhead). (D) Elongation and extraction of the device (red arrowhead). (E and F) Extracted device within the ŌNŌ retrieval basket.

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  Visual Summary. Chronological Clinical Course After ASD Device Embolization and Successful Retrieval Key clinical events, diagnostic evaluations, and interventions surrounding the patient's presentation and management. Note the rapid time from positioning of the ŌNŌ retrieval system to device snaring and retrieval. ASD = atrial septal defect; CXR = chest radiography; CTPE = computed tomography pulmonary angiogram; MPA = main pulmonary artery; RPA = right pulmonary artery.