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Objectives
The Amplatzer™ Septal Occluder is a minimally invasive device used to treat atrial septal defects (ASD). Despite the low associated complication rates, the Amplatzer™ device has, on rare occasions, been found to erode surrounding structures. The authors describe a case in which a patient presented with an aortic root fistula and underwent open surgical repair to remove an Amplatzer™ device that had been percutaneously inserted nine years earlier to repair an ostium secundum ASD.
Methods
A 33-year-old woman presented for evaluation of device erosion into the aortic root, with continuous blood flow between the aorta and right atrium consistent with a fistula. The patient underwent elective surgical repair via a median sternotomy to remove the Amplatzer™ device from the atrial septum. Exploration revealed a fistula from the noncoronary sinus of the aortic root into the right atrium. Repair consisted of removing the device, replacing the aortic wall of the entire noncoronary sinus and the right atrial wall with bovine pericardium, and replacing the atrial septum with autogenous pericardium.
Results
The patient had an uneventful recovery with no complications—including no dysrhythmia or heart block—and was discharged on postoperative day six. Postoperative transesophageal echocardiography showed no postrepair shunt from the noncoronary sinus to the right atrium and an entirely competent aortic valve. The patient has returned to work and remains well five months after the procedure.
Conclusion
Although complications are uncommon after closure of an ASD with an Amplatzer™ Septal Occluder, the device may erode surrounding structures and produce a fistula. Such complications can be successfully repaired with extensive open surgical techniques.
This educational content was originally presented during the STSA 64th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.
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1 Comment
We described a similar complication of atrial septal Amplatzer device (Tex Heart Inst J 2016;43(6):541-2). She was 22-year-old woman and admitted to our emergency department with sudden-onset dyspnea and subsequent syncope. In the initial examination, she was unconscious and in respiratory arrest. After cardiopulmonary resuscitation, she was intubated. Transthoracic echocardiography (TTE) revealed dense pericardial effusion, fibrin, and cardiac tamponade. The patient, in shock, underwent urgent operation.
Intraoperative examination revealed rupture of the left atrial roof and noncoronary aortic sinus, caused by an atrial septal occluder. We placed a temporary pledgeted suture on the ruptured noncoronary sinus of the ascending aorta, to stop the bleeding through a very small perforation. After a standard bicaval cannulation, we initiated cardiopulmonary bypass. The atrial septal occluder was then removed, and a temporary autologous pericardial patch was constructed for the ostial secundum ASD. Finally, the left atrial and noncoronary aortic sinus walls were primarily repaired. The patient was extubated on the first postoperative
day, and no neurologic or other major sequelae were seen. She was discharged on the 5th postoperative day in a good overall condition.