title: Surgical rescue of embolized amplatzer devices.
abstract: OBJECTIVE
  Transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) with Amplatzer septal/duct occluder (ASO/ADO) is an established, safe, and efficient procedure with high success. However, device embolization remains a major complication requiring immediate intervention (either percutaneous or surgical) for retrieval and correction of the heart defect. The aim of this study is to share the experience of managing embolized ASO/ADO.
  
  
  METHODS
  Of the 284 cases of device closure performed from October 2002 to December 2010, four patients (1.4%) had device embolization requiring immediate surgical retrieval. Two adult female patients with secundum ASD had ASO device implanted. One embolized to the right ventricle and the other into the ascending aorta. An eight-month-old boy and a four-year-old girl with hypertensive PDA had device closure. Device embolization occurred into the descending aorta and right pulmonary artery, respectively.
  
  
  RESULTS
  All four devices were retrieved and the defects closed successfully with a low morbidity and no mortality.
  
  
  CONCLUSIONS
  Careful consideration should be given to surgical or transcatheter closure of a heart defect. Life-threatening complications although rare can occur. Our experience strongly suggests that these devices should only be inserted in facilities where cardiac surgical support is immediately available.
authors.affiliation: Cardiothoracic Surgery and Pediatric Cardiology, Aga Khan University Hospital, Karachi, Pakistan. muneer.amanullah@aku.edu
authors.forename: Muneer M
authors.initials: MM
authors.lastname: Amanullah
authors.forename: Maria T
authors.initials: MT
authors.lastname: Siddiqui
authors.forename: Mubashir Z
authors.initials: MZ
authors.lastname: Khan
authors.forename: Mehnaz A
authors.initials: MA
authors.lastname: Atiq
mesh_terms: D000293:Adolescent; D000792:Angiography; D006328:Cardiac Catheterization / Q000379:methods; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D004452:Echocardiography; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D055989:Septal Occluder Device / Q000009:adverse effects*