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Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder

Abhay Divekar, MBBS^_*,_*, Tidimogo Gaamangwe, MSc, PEng, Nasir Shaikh, MBBS, Michael Raabe, MD and John Ducas, MD

^_* Section of Pediatric Cardiology, Health Sciences Center, Winnipeg, Manitoba, Canada
Section of Adult Cardiology, Health Sciences Center, Winnipeg, Manitoba, Canada
Section of Clinical Engineering, Health Sciences Center, Winnipeg, Manitoba, Canada
Section of Cardiovascular and Thoracic Surgery, Health Sciences Center, Winnipeg, Manitoba, Canada.

View larger version (160K): [in a new window]   Figure 1 Transesophageal echocardiogram showing (A) device splayed over aortic root and (B) device without splaying over the aortic root. AO = aorta; ASO = Amplatzer septal occluder; RA = right atrium.

View larger version (145K): [in a new window]   Figure 2 Postmortem illustration shows the atrial septum through the opened right atrium. The surgically closed ASD is seen (open arrow). Probe shows site of right atrial perforation at the edge of the retention disk with and without device superimposition (closed arrows). ASD = atrial septal defect; ASO = Amplatzer septal occluder; RAA = right atrial appendage; TV = tricuspid valve.

View larger version (116K): [in a new window]   Figure 3 Intraoperative illustration shows the atrial septum through the opened right atrium before and after explanting the ASO. The right atrial perforation occurs at the edge of the retention disk (white arrow). AO = aorta; ASD = atrial septal defect; ASO = Amplatzer septal occluder.