title: Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder.
abstract: BACKGROUND
  Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder.
  
  
  METHODS
  Between June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15-45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively.
  
  
  RESULTS
  All of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5-28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22(nd) month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE.
  
  
  CONCLUSIONS
  Transcatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk.
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Yetkin
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Yurekli
authors.affiliation: Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Zehra Ilke
authors.initials: ZI
authors.lastname: Akyildiz
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Gokalp
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Hospital, Bursa, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Tetik
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Lafci
authors.affiliation: Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Ergene
authors.affiliation: Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Gurbuz
keywords: Amplatzer septal occluder; embolization; migration; secundum type atrial septal defect
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