Berk Thirza A, Kroeze Sven, Suttorp Maarten Jan, Heijmen Robin H
Department of Cardiothoracic surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands.
Department of Cardiology, Sint Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands.
Eur Heart J Case Rep. 2023 Feb 28;7(3):ytad099. doi: 10.1093/ehjcr/ytad099. eCollection 2023 Mar.
Percutaneous patent foramen ovale (PFO) closure is considered safe and has been used widely for over 25 years. A rare but potentially life-threatening complication is device migration, especially to the aorta.
We present a 30-year-old male with a PFO occlusion device implanted for cryptogenic stroke, which asymptomatically migrated to the aortic arch. A percutaneous retrieval attempt failed at complete removal but relocated the device to the proximal descending aorta. It was then successfully removed by open surgery. Severe intimal damage necessitated resection and interposition grafting.
Manipulation of migrated intravascular devices can cause intimal damage and subsequent complications, such as local dissections. We advocate caution with percutaneous removal of such large, migrated closure devices to avoid additional intimal damage, especially after endothelialization has occurred. The interventional cardiologist should be aware of the risk of intimal damage as a result, and surgical removal, though invasive, should always be considered.
经皮卵圆孔未闭（PFO）封堵术被认为是安全的，并且已经广泛应用超过25年。一种罕见但可能危及生命的并发症是装置移位，尤其是移位至主动脉。
我们报告一名30岁男性，因不明原因卒中植入了PFO封堵装置，该装置无症状地移位至主动脉弓。经皮取出尝试未能完全取出，但将装置重新定位至降主动脉近端。随后通过开放手术成功取出。严重的内膜损伤需要进行切除和植入血管移植物。
对移位的血管内装置进行操作可导致内膜损伤及随后的并发症，如局部夹层形成。我们主张在经皮取出此类大型移位封堵装置时要谨慎，以避免额外的内膜损伤，尤其是在内皮化已经发生之后。介入心脏病学家应意识到由此导致内膜损伤的风险，并且虽然手术取出具有侵入性，但应始终予以考虑。
