Introduction

Dear Editor,

I wish to provide some perspective about the embolization of an Amplatzer ductal occluder with regard to a recent case report which appeared in your journal. The author, Mr. F. Gümüş,[1] reported his experience on the removal of an embolized Amplatzer patent ductus arteriosus (PDA) occluder device.[1] It was clear from his paper that he had no attempt to perform percutaneous methods before the surgical operation.

As a basic information considering the transcatheter treatment of atrial septal defect and PDA, Amplatzer septal/ductal occluder (ASO/ADO) device has been used safely, efficiently and with success. Unfortunately, the worst complication of this procedure, which is the device embolization, requires immediate intervention either percutaneous or surgical. The device embolization can be seen in 0.55-3.8% of these cases.[2-4] However, this complication should be overcome primarily by percutaneous methods before an open surgical approach. Balbi et al.[2] reported that the success rate of percutaneous retrieval of an embolized device is 50%. Similarly, Chan et al.[5] presented a case of embolized device into the right ventricle and a successful retrieval by using percutaneous gooseneck snare. An embolized device may be simply rescued by using a loop snare, an endocardial biopsy forceps, a Fogarthy catheter, or a 15 mm Amplatz GooseNeck Snare, through a femoral arterial percutaneous access instead of this massive surgical operation.[3-5] In the light of all these aforementioned references, which are the obvious examples of how can an embolized device be rescued, the preference of a surgical option without trying any previous percutaneous maneuver seems to be incorrect.

As the authors mentioned themselves, Gümüş et al. did not try a percutaneous intervention and, instead, they directly switched to an extensive open surgery.

What was the reason for making this decision? Why did they not consider percutaneous options before surgery? Moreover, this contradictiously extensive surgery including both median sternotomy and median laparotomy together in a five-year-old child may cause more serious morbidity and unfortunate results, compared with an existence of PDA itself.

Declaration of conflicting interests

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.