2| CASE PRESENTATION
A 69-year-old woman presented to the emergency department for symptoms
of acute right heart failure including progressive exertional dyspnea
and limbs weakness. Physical examination showed slight cyanosis and cold
limbs. She underwent percutaneous transcatheter closure of a secundum
ASD through femoral vein eight months before. On further investigation,
transthoracic echocardiography (TTE) revealed severe tricuspid
regurgitation and the migrated ASD device (Figure 1), and the
embolization seemed to be located near the left ventricular inflow
tract. Computed tomography (CT) and three-dimensional reconstruction
confirmed the left-side migration of the device, and revealed
obstruction of RPV caused by the embolization (Figure 2). Given the
clinical features and radiological findings, the diagnosis of ASD
closure device migration was decided, and symptoms of heart failure were
caused by RPV obstruction. In consideration of eight months after
percutaneous closure, a safe surgical retrieval procedure reported by
our center before was performed [1]. Standard median sternotomy and
cardiopulmonary bypass were performed first, access was via right
atrium. Then removed the endothelialized tissue around the device, and
the A 3-0 prolene suture is placed through the middle
of the device. The suture is passed through a large (12F) soft plastic
snugger which is advanced well into the atrium, and the ASD was closed
surgically.
Postoperative vital signs were stable and the patient was discharged for
home without symptoms of right heart failure. At the follow up one month
later, TTE revealed no significant residual leaks at the ASD level, and
no dyspnea or weakness was found.