title: Device-in-device: A transcatheter alternative to surgical explantation of a failing atrial septal defect intracardiac prosthesis.
abstract: A failing intracardiac device is traditionally addressed by open-heart surgery. Surgical explantation of the device, although a simple procedure, carries risks that some patients are not able or willing to cope with. Thus, a nonsurgical option seems desirable in selected cases. We report on four cases of early malfunction of the Polyvinyl Alcohol membrane of Ultrasept II™ CARDIA ASD devices. In all cases, transthoracic echo (TTE) surveillance 4-6 months after the index procedure, depicted significant left-to-right atrial shunts through the center portion of the devices. A second nitinol double disk device with a connecting pin (Lifetech CERA™ Multifenestrated ASD device) was implanted over the CARDIA devices, with excellent results. All procedures were uneventful and all patients are asymptomatic with no residual shunts, in short-term follow-up. This device-in-device technique prevents surgical explantation of failing ASD devices, and may become a less invasive option in selected patients. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Interventional Cardiology Division, INTERCAT - Cardiologia Intervencionista, RJ, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Chamié
authors.affiliation: Catheterisation Laboratory, CEDIPAR, Maringá, Brazil.
authors.forename: Julio
authors.initials: J
authors.lastname: Maia
authors.affiliation: Cardiology Department, Instituto Estadual de Cardiologia de Santa Catarina, Florianopolis, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Giuliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000497:Alloys; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008567:Membranes, Artificial; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019233:Retreatment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000497:Alloys; D008567:Membranes, Artificial; C013616:nitinol; D011142:Polyvinyl Alcohol
keywords: ASD closure; complications; polymers