Key result
Transseptal percutaneous retrieval successfully removes embolized Amulet LAA closure device from the LV.
Why the study?
Percutaneous retrieval techniques for embolized left atrial appendage closure devices in the left ventricle require detailed description to guide clinical management.
Case Report (n=1)
This case demonstrates the feasibility of percutaneous transseptal retrieval of an embolized LAA closure device from the left ventricle using a snaring technique.
Answers are grounded in this paper and cite their sources.
Demonstrates successful Amulet implantation using updated EHRA/EAPCI fluoroscopic sizing in an elderly patient; extends consensus application to routine practice.
An interventional left atrial appendage closure procedure was performed in an 87-year-old patient [general anaesthesia and transoesophageal echocardiography (TOE) guidance]. Landing zone was measured fluoroscopically according to the updated European Heart Rhythm Association/European Association of Percutaneous Cardiovascular Interventions expert consensus statement. A 28 mm Amplatzer™ Amulet™ left atrial appendage (LAA) occluder was implanted (Abbott, MN, USA). Fluoroscopic and TOE assessment showed satisfactory device shape and compression, and two tug tests confirmed a stable position inside the LAA. The next day, X-ray and transthoracic echocardiography showed device embolization (Panels A and B, left; Supplementary material online, Video S1). Re-catheterization was performed under TOE guidance (Panel B, right; Supplementary material online, Videos S2 and S3). After transseptal puncture, a 12-French FlexCath Advance Steerable Sheath (Medtronic Inc., MN, USA) was positioned in the left atrium. An ablation catheter was introduced into the left ventricle, and the sheath was advanced beyond mitral annulus (Panel C) over the catheter, which was then retrieved and replaced by an MPA-1 catheter, with its tip pointing directly at the knob at the lobe side of the occluder. A multiplane flower-shaped snaring device (EN Snare 18–30 mm, 7 French, Merit Medical Systems Inc., UT, USA) was slowly pushed out of the MPA-1 catheter, engaging the knob of the occluder and then pulled back into the MPA-1 catheter, snaring the knob and fixing it to the tip of the MPA-1 catheter. By slow but continuous and strong pulling back of the snaring device, the occluder was pulled into the sheath (see Supplementary material online, Video S4) and retrieved without damaging the mitral valve (confirmed by TOE imaging). The patient was discharged the next day. Supplementary material is available at European Heart Journal – Case Reports online. Consent: The patient gave written informed consent to the publication of this case. Funding: None declared. All available data are presented within the manuscript.
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Schratter et al. (2024) conducted a case report in Embolized left atrial appendage closure device (n=1). Percutaneous retrieval via transseptal access was evaluated on Successful device retrieval. Percutaneous retrieval via transseptal access successfully removed an embolized Amplatzer Amulet left atrial appendage closure device from the left ventricle without damaging the mitral valve.
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