Transcatheter retrieval of a fully dislodged atrial septal defect occluder from the descending aorta using the “retained super-stiff guide wire” technique

Device embolisation is one of the most feared early complications of percutaneous atrial septal defect closure. We report a 40-year-old woman in whom a 12-mm atrial septal defect occluder was accidentally displaced into the descending aorta 24 hours after an apparently successful procedure. The dislodged device was retrieved percutaneously through a 12-F long sheath that was continuously railroaded over a super-stiff guide wire. This "retained super-stiff guide wire" technique secured sheath stability, avoided aortic wall trauma, and allowed the occluder to be slipped into the sheath without change of its orientation. A larger 16-mm small-waist-big-edge device was subsequently implanted uneventfully. The technical details and advantages of keeping the sheath constantly over a super-stiff guide wire are highlighted to facilitate safe trans-arterial retrieval of embolised cardiac devices.