Abstract
Transcatheter closure has become the leading approach for closure of most instances of patent ductus arteriosus. However, there are some complications associated with this procedure. We report a case involving the embolization of a device in the right pulmonary artery during placement. A 20-year-old woman was referred to our hospital for percutaneous transcatheter closure of patent ductus arteriosus. During the deployment of an Amplatzer duct occluder device, it was disconnected from the connector and became embolized in the lower branch of the right pulmonary artery. We could not grasp the device with a gooseneck snare. After various attempts, the device was captured and removed by a BiPal bioptome endomyocardial biopsy forceps. Based on our findings, we recommend that endomyocardial biopsy forceps should be considered as an alternative when such complications occur.
Introduction
Recently, transcatheter closure has become the leading approach for closure of most instances of patent ductus arteriosus. 1 Although some satisfactory results of closure with transcatheter devices have been reported, 2 some complications have been reported after these procedures, such as hemolysis, left pulmonary artery stenosis, device protrusion into the aorta causing coarctation, and device misplacement following device embolization. 3 Here, we report a case in which a device became embolized in the right pulmonary artery during placement.
Case Report
A 20-year-old woman was referred to our hospital for percutaneous transcatheter closure of patent ductus arteriosus. Aortography with 6F pigtail catheter showed systolic flow from the aorta to the pulmonary artery (Supplementary File 1). During deployment of the Amplatzer Duct Occluder device (ADO; St. Jude Medical, St. Paul, MN, USA), the device became disconnected from the connector due to operator error and was suddenly embolized in the lower branch of the right pulmonary artery (Figure 1A and B). We attempted retrieval of the patent ductus arteriosus device by percutaneous approach. A 6F Judkins right coronary catheter was advanced into the pulmonary artery with a guidewire (Supplementary File 2). We could not grasp the device with an Amplatz gooseneck snare (Microvena, St. Paul, MN, USA) because the embolized device had become stuck in the branch of the right pulmonary artery. BiPal 7 bioptome, 104 cm (Cordis Corporation, Miami Lakes, FL, USA) was introduced from the left femoral vein through a 7F sheath (Figure 2). After multiple attempts, we captured and removed the embolized device (Supplementary File 3). Subsequently in the same operation, a new ADO (9-PDA-005, St. Jude Medical, St. Paul, MN, USA) device was carefully deployed by venous route (Figure 3A and B). Neither clinical complications nor a residual shunt were observed during 2 years of follow-up.
A, Deployment attempt of the device (white arrow). B, Embolized device in the branch of right pulmonary artery.
Endomyocardial biopsy forceps.
A, Deployment of device. B, Successfully closed patent ductus arteriosus (PDA).
Discussion
Common methods to treat patent ductus arteriosus include surgical ligation with conventional minithoracotomy or video-assisted thoracoscopy, as well as transcatheter occlusion using various coils, springs, and devices. Nonsurgical closure of patent ductus arteriosus with a percutaneously placed duct occluder is currently the first-line therapy and has high success rates. The most significant reported complication of transcatheter closure of patent ductus arteriosus has been device embolization to the pulmonary artery. 4 There have been many case reports regarding surgical treatment of an embolized device. 5 –7 Although it is well defined in patients with atrial septal defect, percutaneous retrieval of an embolized device is rare in patients with patent ductus arteriosus. 8 In our case, we informed the patient of this complication. After suggesting treatment options, including open cardiac surgery and percutaneous removal methods, we obtained consent from the patient to attempt percutaneous removal. After several unsuccessful attempts, the embolized device was captured by use of endomyocardial biopsy forceps. We recommend that endomyocardial biopsy forceps should be considered as an alternative when this type of complication occurs.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
