Journal of Invasive Cardiology

Once the device was fully deployed across the ASD, its position and stability were assessed by fluoroscopy and transesophageal echocardiography (Figure 1C). A gentle pushing and pulling of the delivery cable was performed to ensure a secure and stable device position (Minnesota Wiggle). The delivery system was then unscrewed to release the device. Immediately upon release of the device, fluoroscopy and TEE demonstrated a leftward movement of the right atrial disc with embolisation of the Amplatzer device into the auricle of the left atrium (Figure 1D). Our first attempt was to remove the device with a snare catheter (Goose neck, Microvena, White Bear Lake, Minn.) with a snare loop diameter 35 mm placed into a long sheath and remove it completely from the patient. The snare catheter was introduced next to the embolised device and the screw of the device was caught. Attempts failed to retrieve the embolised device through the atrial septum. During the pooling manoeuvre, the device was lost and embolised again into the left atrium. While checking the position of the device by fluoroscopy and TEE, the device was spontaneously turned round, slowly moved along the septum and covered the ASD. The fluoroscopy showed an “optimal position” of completely turned round (the screw mechanism was in the left atrium) device in previous atrial septal defect, no movement of the device was present. TEE showed only a insignificant central residual shunting. We thought this situation to be very unstable and our goal was to pull the device into the right atrium and remove it during open heart surgery. We again tried to catch the device by the snare catheter but once the device “placed itself” into the defect, to introduce any catheter into the left atrium was not possible. Eventually, we decided to remove the device with biopsy forceps (Cordis Corporation, Miami, Florida) but even after the catching the device with biopsy forseps branches, we failed to pull it in the right atrium due to fixed position of the device in the ASD. Furthermore, the occluder was so tightly catched in the septum that it was not able to push it back in the left atrium.