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OBJECTIVE:
To describe an Amplatzer Septal Occluder (ASO) late embolization into the Pulmunary Trunk, ten months after the implant, and the successful surgical removal through a video-guided Port-Access approach.
METHODS:
An ostium secundum Atrial Septal Defect (ASD) was percutaneously closed with an ASO implant in a 30-year-old woman. The procedure was uneventful and the pre-discharge echocardiography confirmed the correct position of the device. Ten months later, a transthoracic echocardiography showed the migration of the device into the pulmonary trunk. The transcatheter removal was not possible and the patient was then referred to our Cardiac Surgery Unit. At our Institution Port-Access technique is routinely used for all patients undergoing mitral and tricuspid valve surgery, so we adopted this technique to remove the ASO. After a 4 cm right submammary incision, the fourth intercostal space was entered and the pericardium opened. Cardiopulmonary bypass was established through cannulation of left femoral artery, right femoral and jugular vein. Malleable transthoracic aortic cross-clamp (Cygnet) was used and cold crystalloid cardioplegia was delivered. Optics was introduced into the third intercostals space. A right atriotomy was performed and the ASD was found and directly closed with a prolene 4-0 suture. Videoscopy was extremely useful in order to reach the pulmonary trunk and a transverse arteriotomy was carried out. The ASO was carefully removed detaching the device from organized endothelial adhesions. The pulmunary trunk was finally sutured. The operation was then concluded in the appropriate manner.
RESULTS:
Aortic cross clamp and CPB time were 51 and 61 minutes respectively. The postoperative course was uneventful. The patient was discharged from the ICU on the first postoperative day and from the hospital on the fifth postoperative day in a good clinical condition.
CONCLUSIONS:
This case shows that the Port-Access technique for surgical procedures on the pulmonary trunk is feasible, safe and effective. Moreover, complications after transcatheter interventions are not frequent but often requiring surgical management; therefore a less invasive technique, mainly in young patients, is a well accepted option, improves surgical results and patient’s satisfaction and quality of life.