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.