Percutaneous Retrieval of an Amplatzer Septal Occluder Device that had migrated to the Aortic Arch

The secundum type atrial septal defect (ASD) is a relatively common finding in the general population, occurring at a reported rate of 3.78 per 100,000 live births [1], and comprising approximately 6–10% of all congenital cardiac defects [2]. When faced with a symptomatic ASD, there are several methods of treatment available. Open surgery with occlusion of the ASD is the time-honored treatment [3], but percutaneous placement of an occluder device has been the preferred treatment for several years [4]. The choice for the closure method is mainly based on the severity of symptoms, the underlying medical condition, cardiovascular anatomy [5, 6], and the size of the septal defect [7]. Surgical repair has been practiced for more than 50 years and often is preferred when the ASD size is larger and the symptoms are more severe [3]. However, percutaneous occluder device placement has largely replaced surgery when the patient is incapable of withstanding a major procedure, when the septal defect is\24 mm [8], and when the septal defect is not located near other vital cardiovascular structures [6]. The Amplatzer septal occluder (ASO) device has been extensively studied for the percutaneous closure of both ventricular as well as atrial septal defects [9, 10]. Using the approach first described in 1976 by King and Mills [4], the Amplatzer device can be placed via a venous route, and may be secured without placing the patient under general anesthesia or using cardiopulmonary bypass. Although percutaneous device placement has been found to have a lower rate of overall complications than surgical closure [5], there have been several reports of adverse events in the literature [5, 6, 8]. The case presented here describes a complication that has not yet been reported, related to the migration of the device to the aortic arch.