Lost but Found: Occluder Device Embolization
A Rare Case & Key Teaching Points
What is An ASD?
An atrial septal defect is a hole in the interatrial wall that separates the left and the right atrium. This abnormal communication creates a new passageway for blood to flow and echocardiography is used to assess the size, location, flow direction, chamber dilation, and hemodynamic effects of this abnormal finding.
Atrial septal occluder devices are a common treatment option for this pathology and involve a catheter-based procedure to implant the device. A properly sized occluder is a permanent solution to seal off the hole and these can range from 4mm-4mm in diameter. In most cases, an atrial septal defect is a congenital defect affecting 8 out of 10,000 babies, according to the Cleveland Clinic, but adult patients can also be affected if the foramen ovale opens back up later in life.
What Are Occluder Devices Made of?
These devices are often made of a wire frame comprised of nickel, titanium, and sometimes platinum with a polyester fabric covering. Cardiac closure devices typically have two round disks with a narrow mesh “waist” in between. A disk will mount in each atria against the septum and the waist connects them, sitting inside of the hole (Cleveland Clinic, 2024).
After successful implantation, the patient's endothelial cells gradually grow over the surface of the new device, allowing it to integrate with the heart tissue and preventing blood clots from forming on the device.
Complications
Success rates exceed 93% in recent studies, but the other 7% may experience complications from the procedure including atrial fibrillation, hematoma in the groin at the puncture site, residual shunting, endocarditis, device-related erosion, device thrombosis, or in this case… device embolization.
Some of you may never encounter this rare echocardiographic finding in your entire career. But today, we have the unique opportunity to share this invaluable teaching case with you. What happens next might just change how you approach this condition—keep reading to find out...