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The ‘aortic rim’ recount: embolization of interatrial septal occluder into the main pulmonary artery bifurcation after atrial septal defect closure

^a Department of Cardio-Vascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India-695 011
^b Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India-695 011

*Corresponding author. Tel.: +91 471 2524648; fax: +91 471 2446433.

E-mail address: ranjan{at}sctimst.ac.in (M. Misra).

Introduction: Percutaneous device closure of atrial septal defect (ASD) has emerged as an alternative to traditional surgical closure. Although reduced hospital stay, decreased morbidity and absence of a surgical incision are beneficial, other procedure- or device-related complications are coming into light. We report a rare complication of early embolization of the Blockaid septal occluder into the main pulmonary artery bifurcation associated with ‘aortic rim’ erosion and present a brief review of literature pertaining to the high incidence of complications associated with deficient or eroded ‘aortic rims’ necessitating surgical intervention. Material and methods: An 18-year-old male underwent successful percutaneous device closure of a 24.5 mm ASD after fulfilling institutional criteria for the procedure. The device used was a Blockaid septal occluder, a device morphologically similar to the Amplatzer device. The subsequent day, he had embolization of the device into the main pulmonary artery bifurcation, and underwent emergency surgical retrieval of the same with closure of the ASD. At surgery the ASD was found to have an eroded aortic rim. Comments: We believe that embolization of the percutaneous septal occluder in our patient was due to a combination of factors including an inadequate aortic rim; a grossly oversized device which eroded the aortic rim; and the Blockaid septal occluder, whose formally untested design and configuration could have led to its migration. Conclusion: Strict selection criteria governing an ‘adequate’ aortic rim, the size of the device, and the choice of the device may help reduce the incidence of complications like the rare, but potentially fatal embolization of the device into the pulmonary artery following percutaneous device closure of an ASD.

Key Words: Congenital; Acyanotic; Device; Embolism

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