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Erschienen in: Wiener klinische Wochenschrift 15-16/2021

Open Access 15.06.2021 | images in clinical medicine

Unexpected early migration of a patent foramen ovale occluder

verfasst von: Ao. Univ.-Prof. Dr. Johannes Mair, Dr. Silvana Müller, Univ-Prof. Dr. Axel Bauer

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 15-16/2021

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Supplementary video 1: Fluoroscopy of a vigorous “wiggle” test before release of the Occlutech® Figulla® Flex II 23/25 mm PFO occluder. The occluder remained in stable position while still being connected to the delivery system.
Supplementary video 2: Successful interventional retrieval of the embolized Occlutech® Figulla® Flex II 23/25 mm patent foramen ovale occluder through a 18 French 30 cm long femoral sheath using a 35 mm goose neck snare kit
Supplementary video 3: Transesophageal echocardiogram of a vigorous push of the Amplatzer™ 30 mm patent foramen ovale occluder. The right atrial disc migrated into the tunnel upon this vigorous push, which was also the obvious cause of the embolization of the 25/23 mm Occlutech® Figulla II® occluder.
Hinweise

Video online

The online version of this article contains 3 videos. The article and the videos are online available (https://​doi.​org/​10.​1007/​s00508-021-01894-z). The videos can be found in the article back matter as “Supplementary Information”.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
LA
Left atrium
PFO
Patent foramen ovale
RA
Right atrium
A Figulla® Flex II 23/25 mm patent foramen ovale (PFO) occluder (Occlutech®, Jena, Germany) was deployed across the atrial septum. Correct positioning was confirmed by fluoroscopy demonstrating the “pacman” sign (Fig. 1a arrow; the septum secundum is lying between both discs) without residual shunt in angiography via the delivery sheath (Fig. 1a), transesophageal echocardiography (TEE) (Fig. 1b, the septum primum and secundum are lying between both discs without partial deployment of its right atrial disc within the PFO tunnel; delivery system marked with arrow), and by stable position on repeated bidirectional “wiggle” maneuvers (supplementary video 1). Despite passing these checks it slipped unexpectedly from the atrial septum and embolized to the proximal abdominal aorta on intense coughing after its release. The PFO occluder migration could be successfully managed by percutaneous retrieval (Fig. 1c, see supplementary video 2). Careful PFO reassessment revealed a large, high-risk, long-tunnel PFO (length 21 mm, width 6 mm, septum secundum thickness 6 mm) with a hypermobile atrial septum (septal excursion 10 mm) and a large Eustachian valve (Fig. 1d, arrow). A larger, somewhat less compliant Amplatzer™ 30-mm PFO occluder (Abbott®, Vienna, Austria) was deployed across the PFO and released in the correct position (Fig. 1e) despite a single dislocation of its right atrial disc into the PFO tunnel upon a vigorous push (Fig. 1f, supplementary video 3), because this device was stable afterwards with several repeat “push and pull” maneuvers and a 35 mm PFO occluder was deemed to be too large in this patient considering the risk of erosion and residual shunt. There was no residual shunt in a follow-up TEE after 7 months. The importance of careful assessment of true PFO tunnel length in preprocedural TEE for device size selection is stressed. Other anatomical predisposing factors (atrial septal aneurysm, a > 10 mm thick septum secundum) for occluder migration were not present in this patient [13].

Conflict of interest

J. Mair, S. Müller and A. Bauer declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Information

Supplementary video 1: Fluoroscopy of a vigorous “wiggle” test before release of the Occlutech® Figulla® Flex II 23/25 mm PFO occluder. The occluder remained in stable position while still being connected to the delivery system.
Supplementary video 2: Successful interventional retrieval of the embolized Occlutech® Figulla® Flex II 23/25 mm patent foramen ovale occluder through a 18 French 30 cm long femoral sheath using a 35 mm goose neck snare kit
Supplementary video 3: Transesophageal echocardiogram of a vigorous push of the Amplatzer™ 30 mm patent foramen ovale occluder. The right atrial disc migrated into the tunnel upon this vigorous push, which was also the obvious cause of the embolization of the 25/23 mm Occlutech® Figulla II® occluder.
Literatur
1.
Zurück zum Zitat Schwerzmann M, Salehian O. Hazards of percutaneous PFO closure. Eur J Echocardiogr. 2005;6:393–5. CrossRef Schwerzmann M, Salehian O. Hazards of percutaneous PFO closure. Eur J Echocardiogr. 2005;6:393–5. CrossRef
2.
Zurück zum Zitat Price MJ. Transcatheter closure of patent foramen ovale—devices and technique. Interv Cardiol Clin. 2017;6:555–67. PubMed Price MJ. Transcatheter closure of patent foramen ovale—devices and technique. Interv Cardiol Clin. 2017;6:555–67. PubMed
3.
Zurück zum Zitat Goel SS, Aksoy O, Tuzcu EM, Krasuski RA, Kapadia SR. Embolization of patent foramen ovale closure devices. Tex Heart J. 2013;40:439–44. Goel SS, Aksoy O, Tuzcu EM, Krasuski RA, Kapadia SR. Embolization of patent foramen ovale closure devices. Tex Heart J. 2013;40:439–44.
Metadaten
Titel
Unexpected early migration of a patent foramen ovale occluder
verfasst von
Ao. Univ.-Prof. Dr. Johannes Mair
Dr. Silvana Müller
Univ-Prof. Dr. Axel Bauer
Publikationsdatum
15.06.2021
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 15-16/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-021-01894-z