European Heart Journal Advance Access originally published online on January 24, 2008
European Heart Journal 2008 29(14):1791; doi:10.1093/eurheartj/ehm640
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Percutaneous removal of embolized Amplatzer occluder from the abdominal aorta: a different type of belly-button
1 Department of Diagnostic Radiology, University of Regensburg Medical Center
2 Department of Vascular Surgery, Barmherzige Brueder Regensburg
3 Department of Cardiology, University of Regensburg Medical Center
* Corresponding author. Tel: +49 9419447410; Fax: +49 9419447402, Email: niels.zorger{at}klinik.uni-regensburg.de
A 71-year-old woman was admitted 6 months after placement of an Amplatzer septal occluder because of a secundum ASD. Routine echocardiography failed to identify the device in the correct position. Fluoroscopy revealed a dislocation in projection to the abdominal aorta. A contrast-enhanced computer tomography (CT) confirmed the dislocation into the abdominal aorta at the position of the ostium of the superior mesenteric artery (Panels A and B).
The right common femoral artery was surgically explored and punctured, and a 20 F sheath was positioned close to the Amplatzer device. A lasso was used to grab the screw mechanism of the right atrial disk and pull the device into sheath (Panel C).
Macroscopic inspection of the retrieved occluder showed an intact device with signs of neointimal proliferation originating from the sewn-in polyester mesh and partially covering the Nitinol wires (Panel D). Histological examination of the neointimal tissue showed granulation tissue with occasional hemosiderophages, strong infiltration and proliferation of fibroblasts, and deposition of connective tissue around the polyester mesh, all consistent with a strong foreign body reaction (Panel E).
In most cases, embolization of an Amplatzer device occurs in the pulmonary arteries, probably as a result of an undersizing of the occluder device. To the best of our knowledge, embolization and percutaneous retrieval of an Amplatzer occluder in the abdominal aorta close to the superior mesenteric artery have not yet been described.
Panel A and B. Contrast-enhanced CT scan (sagittal and coronal reconstruction) of the abdominal aorta shows dislocation of the Amplatzer device into the abdominal aorta.
Panel C. A lasso catheter was used to grasp the screw mechanism of the right atrial disk and to pull the device into the sheath.
Panels D and E. Macroscopic appearance and histological examination (HE, 400x magnification, courtesy Dr. S. Bertz, Inst. of Pathology) of the retrieved Amplatzer device with neointimal proliferation.
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