Percutaneous closure of ASD in adults has emerged
as an alternative to surgery. Acute failure of these
devices may occur due to several reasons, the most
critical condition being poor patient and/or device
selection.[
2] The other suggested mechanisms of
acute failure are as follows: operator-related failure
resulting from inadequate experience (learning curve),
inaccurate placement, inadequate defect rim to hold
the device, tearing of the interatrial septum, at the
lower rim of the ASD during catheter, particularly,
and device manipulation.[
3] According to Boysan et
al.[
4] coughing may be an interesting reason for device
embolization.
A part of the device or the whole device may
embolize to the right or left atrium, to the main
pulmonary artery, or even to the other parts of the vascular tree. Embolization into left ventricle is
rarer compared the right ventricle and pulmonary
artery. Percutaneous retrieval of the embolized
device is possible in about 70% of cases, and several
techniques have been described, including the use
of large sheaths, snares, or bioptomes.[5] However,
some authors suggest that embolization of device is
always an indication for emergency surgical retrieval,
which also permits a direct inspection of intra-cardiac
structures that may have become injured.[6] In our patient, we also preferred surgical approach due to
close relation of device with mitral valve in the left
ventricle.
Late postoperative cardiac tamponade is an
uncommon, but potentially lethal condition. Several
authors have asserted that excessive anticoagulation
in the postoperative period is responsible for late
postoperative tamponade. Pericardiocentesis with
catheter placement is highly effective and patients
can be re-anticoagulated safely. In a Mayo Clinic
series, echocardiography-guided pericardiocentesis
was successful in withdrawing pericardial fluid or
relieving tamponade in 97% of the procedures.[7]
Major complications including chamber laceration,
intercostal vessel injury, pneumothorax requiring a
chest tube, sustained ventricular tachycardia (VT),
bacteremia, and death occurred in 1.2% of patients.[8]
Tsang et al.[9] from Mayo Clinic reviewed 245 patients
necessitating pericardiocentesis after cardiac surgery
and showed 0.8% incidence of ventricular perforation.
In our case, perforation of right ventricle was
diagnosed during pericardiocentesis and the patient
was then taken into operation urgently.
In conclusion, a careful echocardiographic
assessment and procedure planning should be done
for a percutaneous intervention. In addition, surgical
back-up must be available in the hospital to cope
with potentially lethal acute complications.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.
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