Late Percutaneous Retrieval of a Septal Occluder to Facilitate Left Atrial Access

We describe intentional retrieval of a well-seated septal occluder device for left atrial access. A 28-year-old woman with platypnea-orthodeoxia and exertional desaturation down to 50% underwent patent foramen ovale closure. She developed refractory atrial tachycardia requiring left atrial mapping. Twenty days later, the device was retrieved percutaneously. Partial endothelization prevented resheathing, so the device and sheath were withdrawn together. The snare slipped in the inferior vena cava, and the device migrated into the main pulmonary artery before recapture and extraction. After multiple electrophysiology procedures, a Gore Cardioform occluder was implanted to preserve future transseptal access. This case demonstrates the technical challenges of retrieving a partially endothelialized occluder and the value of proactive device-control strategies. Device retrieval during early endothelialization can carry migration risk due to device stiffness; balloon stabilization may prevent it. Anticipating future transseptal needs should guide device choice at reclosure.