Percutaneous management of late occluder dislodgement: A case report.

Percutaneous closure of ASD is nowadays preferred and more widely performed over surgical closure. The GORE® CARDIOFORM ASD occluder (GCA) is the latest generation of occluder with promising results as it performed well with high successful implant rates (96%) and showed high efficacy in challenging clinical and anatomical situations. We present the case of a 65 female with a 2.5 cm ASD, left atrial hypertension, deficient retroaortic rim, mobile septum primum and hypertrophied septum secundum. She underwent uncomplicated closure with a 44-mm GCA. However, the patient presented to the emergency room five weeks post procedure and was found to be in atrial fibrillation with rapid ventricular response at a rate of 158 bpm. Further workup showed a dislodged GCA device despite appropriate device placement and size selection based on the published instructions for use. We elected to not remove the 44-mm GCA given that it had become adherent to the septum primum but instead used the stiffer Amplatzer septal occluder to stabilize the GCA and occlude the residual defect. Finally, we highly recommend taking device destabilizing factors into consideration when selecting device size.