Amanullah Muneer M, Siddiqui Maria T, Khan Mubashir Z, Atiq Mehnaz A
Cardiothoracic Surgery and Pediatric Cardiology, Aga Khan University Hospital, Karachi, Pakistan.
J Card Surg. 2011 May;26(3):254-8. doi: 10.1111/j.1540-8191.2011.01249.x. Epub 2011 Apr 11.
Transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) with Amplatzer septal/duct occluder (ASO/ADO) is an established, safe, and efficient procedure with high success. However, device embolization remains a major complication requiring immediate intervention (either percutaneous or surgical) for retrieval and correction of the heart defect. The aim of this study is to share the experience of managing embolized ASO/ADO.
Of the 284 cases of device closure performed from October 2002 to December 2010, four patients (1.4%) had device embolization requiring immediate surgical retrieval. Two adult female patients with secundum ASD had ASO device implanted. One embolized to the right ventricle and the other into the ascending aorta. An eight-month-old boy and a four-year-old girl with hypertensive PDA had device closure. Device embolization occurred into the descending aorta and right pulmonary artery, respectively.
All four devices were retrieved and the defects closed successfully with a low morbidity and no mortality.
Careful consideration should be given to surgical or transcatheter closure of a heart defect. Life-threatening complications although rare can occur. Our experience strongly suggests that these devices should only be inserted in facilities where cardiac surgical support is immediately available.
使用Amplatzer房间隔/动脉导管封堵器（ASO/ADO）经导管闭合房间隔缺损（ASD）和动脉导管未闭（PDA）是一种成熟、安全且高效的手术，成功率很高。然而，装置栓塞仍然是一种主要并发症，需要立即进行干预（经皮或手术）以取出并纠正心脏缺损。本研究的目的是分享处理栓塞的ASO/ADO的经验。
在2002年10月至2010年12月进行的284例装置闭合手术中，4例患者（1.4%）发生装置栓塞，需要立即进行手术取出。两名继发孔型ASD成年女性患者植入了ASO装置。一枚栓塞至右心室，另一枚栓塞至升主动脉。一名8个月大男孩和一名4岁女孩患有高血压性PDA，进行了装置闭合手术。装置分别栓塞至降主动脉和右肺动脉。
所有4枚装置均被取出，缺损成功闭合，发病率低且无死亡病例。
对于心脏缺损的手术或经导管闭合应仔细考虑。尽管危及生命的并发症很少见，但仍可能发生。我们的经验强烈表明，这些装置仅应在有心脏外科支持的机构中植入。
