Technological advances in interventional transcatheter
closure of PDA provide simple and routine
techniques with shorter hospital stay, less mortality
and morbidity rates.[
3] Moreover, it also reduce surgical
risk factors and inevitable operation scar of surgery.
Since it was first described by Porstmann et al.[
4] in
1967, variable devices have been introduced into the
clinical practice. Gianturco and Cook detachable coils
have been proven both safe and effective in closure
of small to moderate size of PDAs,[
5] while ADO
device and Nit-occlud“ device have been developed
to meet relatively favorable outcomes in moderate to
large PDAs.[
6] However, the procedure is not free of
complications, which may include residual shunt with
or without hemolysis, protrusion or migration of the
device into aorta or pulmonary artery, endocarditis, thromboembolization and wire fracture or device
disruption.[
7] Major complication risk is almost 10% in
some studies.[
8] Embolization of the device has been
identified as one of the most significant complications
of intervention.[
9] It may occur in unexpected sites of
circulatory system and cause serious damage. In the
present case report, the device was first embolized
into the descending aorta and then into the abdominal
aorta.
Immediate surgical intervention to remove
migrated device is indicated in patients who are
hemodynamically unstable. Even in patients who
are hemodynamically stable, immediate surgical
intervention is preferred, as it facilitates the removal
of the device before embolization. Most of the
surgical attempts to remove those devices which
migrated into descending aorta are done through
median sternotomy with or without the aid of
cardiopulmonary bypass. In our case, we initially
performed median sternotomy to remove the partly
dislodged device from juxtaductal descending aorta;
however, we were unable to reach, due to the
remigration of the occluder into the abdominal
aorta. Therefore, we performed an abdominal
incision.
In conclusion, percutaneous closure of ductus
arteriosus is a safe and effective alternative to
surgery, however, complications may be seen
in those with unfavorable duct anatomy. Possible
mismatch between implanted occluder size and
anatomical PDA diameters could be the reason for the phenomenon of PDA underestimation and subsequent
complications. Surgical back-up is also important for
such interventional procedures. Although rarely seen,
re-migration of migrated devices may occur and open
abdominal surgery may be required as a life-saving
emergency procedure for device retrieval.
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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