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Zhou H, Wang B, Pan J, Qiu C, Yu X, He Y, Zhu Q, Yu L, Wu Z, Li D, Zhang H. Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review. Front Cardiovasc Med 2023; 10:1127131. [PMID: 37229221 PMCID: PMC10203901 DOI: 10.3389/fcvm.2023.1127131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Intracardiac foreign bodies (IFB) are rare clinical conditions. There are now several reports on the percutaneous retrieval of IFB under fluoroscopy. However, some IFB are not radiopaque, and retrieval requires combined fluoroscopic and ultrasound guidance. We report the case of a bedridden 23-year-old male patient with T-lymphoblastic lymphoma treated with long-term chemotherapy. Ultrasound examination diagnosed a huge thrombus in the right atrium near the opening of the inferior vena cava which affected the patency of his PICC line. Ten days of anticoagulant therapy did not modify the thrombus size. Open heart surgery was not feasible because of the patient clinical condition. Snare-capture of the non-opaque thrombus was done from the femoral vein under fluoroscopic and ultrasound guidance with excellent outcomes. We also present a systematic review of IFB. We found out that percutaneous removal of IFBs is a safe and effective procedure. The youngest patient who received percutaneous IFB retrieval was 10 days old and weighed only 800 g, while the oldest patient was 70 years old. Port catheters (43.5%) and PICC lines (42.3%) were the most commonly found IFBs. Snare catheters and forceps were the most commonly used instruments.
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Affiliation(s)
- Huaji Zhou
- Department of Vascular Surgery, The NO.1 People’s Hospital of Pinghu, Jiaxing, China
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyu Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Mansour MJ, Bénic C, Didier R, Noel A, Gilard M, Mansourati J. Late discovery of left atrial appendage occluder device embolization: a case report. BMC Cardiovasc Disord 2020; 20:305. [PMID: 32571300 PMCID: PMC7310060 DOI: 10.1186/s12872-020-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial appendage (LAA) closure has been well evaluated in the prevention of stroke in patients with atrial fibrillation. Device embolization remains one of the most common complications. To the best of our knowledge, there have been no reports of late discovery of LAA occluder device embolization at 1.5 years after implantation. CASE PRESENTATION We describe the case of a 77-year-old man who underwent uneventful LAA closure. Echocardiography performed the next day showed the device in place. The patient was discharged but was then lost to follow-up. 1.5 years later, he was admitted for ischemic stroke. Transesophageal echocardiography showed the absence of the occluder device in the LAA. Computed tomography scan of the abdomen showed the device in the abdominal aorta. Due to the high cardiovascular risk, the device was kept in place and the patient was treated medically. CONCLUSIONS Per-procedural and late device embolization are not uncommon. Review of the literature however showed no report of late discovery of device embolization at 1.5 years. Follow-up echocardiography is mandatory for the detection of endothelialization or embolization.
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Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.,Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Clément Bénic
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Antoine Noel
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France. .,Université de Bretagne Occidentale, Brest, France.
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Maldonado Fernández N, López Espada C, Linares Palomino JP, Pérez Vallecillos P, García Róspide V. Migration and Surgical Retrieval of an Amplatzer Septal Occluder into Abdominal Aorta. Ann Vasc Surg 2020; 69:449.e11-449.e16. [PMID: 32502671 DOI: 10.1016/j.avsg.2020.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Structural heart defects, secondary to congenital malformations, have been commonly repaired by open cardiac surgery. Endovascular technology enables these repairs to be performed with fewer complications and better recovery. However, endovascular therapy can be associated with major complications as device dislocation or embolization. We present the case of migration of an Amplatzer occluder device into the abdominal aorta and its surgical retrieval. CLINICAL CASE A 10-year-old child with ostium secundum-type interatrial communication underwent endovascular repair in our center. Cardiologists sorted out the atrial communication by endovascular deployment of an Amplatzer device. The 24-h ultrasound control study showed the loss of the occluder. An angio-CT scan showed the migration of the Amplatzer into the juxtarenal abdominal aorta. Initially, an endovascular rescue was attempted but was not effective. Our vascular team performed a median laparotomy, control of the abdominal aorta proximal to the renal arteries, and control of the renal arteries and the infrarenal aorta. We performed a transverse arteriotomy, and the material was removed. Subsequently, the arteriotomy was closed directly without any patch. Postoperative evolution was uneventful. COMMENTS Most of the migrations and embolizations of the devices to close interatrial communications remain intracardiac. Although embolization of the abdominal aorta is only reported sporadically, it could cause a major vascular complication. Percutaneous retrieval of the device is currently recommended, with conventional surgery being the efficient treatment in case of endovascular failure or severe damage to the aorta.
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Affiliation(s)
- Nicolás Maldonado Fernández
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
| | - Cristina López Espada
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain.
| | | | - Pablo Pérez Vallecillos
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
| | - Vicente García Róspide
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
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Afzal MR, Ellis CR, Gabriels J, El-Chami M, Amin A, Fanari Z, Delurgio D, John RM, Patel A, Haldis TA, Goldstein JA, Yakubov S, Daoud EG, Hummel JD. Percutaneous approaches for retrieval of an embolized or malpositioned left atrial appendage closure device: A multicenter experience. Heart Rhythm 2020; 17:1545-1553. [PMID: 32464184 DOI: 10.1016/j.hrthm.2020.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Experience with retrieval of a Watchman left atrial (LA) appendage (LAA) closure device (WD) is limited. An embolized or grossly malpositioned WD warrants retrieval to minimize the risk of thromboembolic complications and vascular occlusion. OBJECTIVE The purpose of this study was to report approaches for percutaneous retrieval of a WD from multicenter experience. METHODS Data on successful WD retrievals were obtained from high-volume operators. Data included clinical characteristics; structural characteristics of the LA and LAA; and procedural details of the deployment and retrieval procedure, type of retrieval (immediate: during the same procedure; delayed: during a separate procedure after the successful deployment), equipment used, complications, and postretrieval management. RESULTS Ten successful percutaneous and 1 surgical retrievals comprised this study. Seven patients had immediate retrieval, while 4 had delayed retrieval. The median duration before delayed retrieval was 45 days (range 1-45 days). The median LAA diameter and size of a successfully deployed WD was 16 mm (range 14-24 mm) and 21 mm (range 21-30 mm), respectively. A WD was retrieved from the LA (n = 1), LAA (n = 2), left ventricle (n = 2), and aorta (n = 6). The reason for retrieval from the LAA was inadequate deployment, resulting in a significant peri-device leak. Retrieval from the LA or LAA was successfully performed using snares (n = 2) and a Raptor grasping device (n = 1). Retrieval from the left ventricle was achieved with a snare (n = 1) and surgery (n = 1). Retrieval from the aorta required snares (n = 5) and retrieval forceps (n = 1). Five patients were successfully reimplanted with a larger size WD. The only complication during percutaneous retrieval was a pseudoaneurysm. CONCLUSION Retrieval of an embolized or malpositioned WD is feasible, and familiarity with snares and grasping tools can facilitate a successful removal.
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Affiliation(s)
| | | | - James Gabriels
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | | | - Anish Amin
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Zaher Fanari
- University of Kansas Medical Center, Wichita, Kansas
| | | | - Roy M John
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | - Apoor Patel
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | | | | | - Steven Yakubov
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Emile G Daoud
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Chopra M, Wong YH, Søndergaard L, De Backer O. Percutaneous retrieval of an embolized left atrial appendage closure device from the left atrium in a patient with previous MitraClips. BMC Cardiovasc Disord 2019; 19:196. [PMID: 31412774 PMCID: PMC6693090 DOI: 10.1186/s12872-019-1170-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 07/24/2019] [Indexed: 11/15/2022] Open
Abstract
Background Left atrial appendage closure is increasingly used. LAA closure procedures can rarely be complicated by device embolization, typically towards the aorta. In this case report, we describe the successful percutaneous retrieval of an embolized Amulet device from the left atrium in a patient with previous MitraClips. Case presentation By guidance of intracardiac echocardiography (ICE) and under local anaesthesia, two guiding systems were introduced into the LA; one to stabilize the device against the lateral LA wall and one large system to retrieve the device. However, the LAA closure device was finally snared by a three-loop snare and pulled across the interatrial septum (IAS) without taking the device into a protective guiding sheath – and this without tearing the IAS. Conclusions In conclusion, percutaneous retrieval of an embolized LAA closure device from the LA is feasible by transseptal approach under local anaesthesia and with ICE guidance. Electronic supplementary material The online version of this article (10.1186/s12872-019-1170-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manik Chopra
- Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Yam-Hong Wong
- Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Medicine and Geriatrics Department, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong.
| | - Lars Søndergaard
- Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ole De Backer
- Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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