CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
e3
Most cases of displacement of the closure device after
successful implantation occur relatively early.
11,12
However,
delayed embolisation may happen and it can be dangerous.
Most embolised devices can be retrieved by percutaneous
techniques,
13,14
however, some patients require surgical removal
and subsequent surgical closure of the ASD.
We report on the delayed and silent embolisation of anAmplatzer
device, which caused partial obstruction of the LVOT one month
after successful percutaneous ASD closure. There is a possibility
that the embolisation had occurred earlier and symptoms had only
developed later. However, in the out-patient department on follow
up 14 days after his discharge, the patient had not complained of
any symptoms and there was no systolic murmur. This was only
heard at the second visit due to symptom recurrence at one month.
Some reports recommend routine TTE during the follow-up
period,
10
however, careful physical examination or a simple chest
X-ray could replace routine echocardiography, with a lower cost
expenditure, as seen in our case.
Conclusion
PercutaneousASD closure is a relatively safe procedure with a low
complication rate. However, even after successful implantation,
as in our case, complications such as device embolisation may
occur at a later stage. Therefore close monitoring, with a physical
examination, chest X-ray and/or TTE, should be continued for a
longer period of time after successful implantation of an ASD
closure device.
This study was supported by a grant from the Korea Healthcare Technology
R+D project, Ministry of Health, Welfare and Family Affairs, Republic of
Korea (HI13C1398).
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Fig. 3.
Transthoracic echocardiography of the displaced Amplatzer closure device (arrow), which was trapped in the LVOT, with
partial obstruction.
