ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology
A massive left-to-right shunt due to delayed spontaneous perforation of polyvinyl alcohol membrane of atrial septal occluder [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2017; 45(6): 541-544 | DOI: 10.5543/tkda.2017.04640

A massive left-to-right shunt due to delayed spontaneous perforation of polyvinyl alcohol membrane of atrial septal occluder

Serdar Bozyel1, Tayfun Şahin2, Emir Dervis2, Müjdat Aktaş2, Hüseyin Şaşkın3
1Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
2Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
3Department of Cardiovascular Surgery, Derince Training and Research Hospital, Kocaeli, Turkey

Percutaneous closure of an atrial septal defect (ASD) has emerged as an alternative to surgery. A 54-year-old woman with a history of percutaneous ASD closure with a 30-mm Cardia Ultrasept septal occluder (Cardia Inc., Eagan, MN, USA) comprising 2 discs made of Nitinol wire mesh covered with polyvinyl alcohol (PVA) membrane, was admitted to the hospital with unstable angina pectoris. In a routine examination, transthoracic echocardiography revealed a left-to-right shunt through the device. Transesophageal echocardiography (TEE) also demonstrated significant left-to-right shunt through the central portion of the prosthesis. Coronary angiography was performed, which disclosed severe stenosis in the right and left anterior descending coronary arteries. Three-dimensional TEE showed multiple perforations of the PVA membrane with intact nitinol frame. Surgical removal of failing device and closure of the ASD with a pericardial patch was performed together with coronary artery bypass graft surgery. On perioperative view, the device appeared to have been correctly implanted, and the device frame was completely intact; however, the PVA membrane of both the right and left discs had almost completely disappeared and there was incomplete endothelialization around the frame. Surgeons must be aware of this rarely seen complication and they should re-examine all patients implanted with Cardia devices in regular follow-up examinations for a long period of time.

Keywords: Atrial septal occlude, polyvinyl alcohol membrane, perforation.

How to cite this article
Serdar Bozyel, Tayfun Şahin, Emir Dervis, Müjdat Aktaş, Hüseyin Şaşkın. A massive left-to-right shunt due to delayed spontaneous perforation of polyvinyl alcohol membrane of atrial septal occluder. Turk Kardiyol Dern Ars. 2017; 45(6): 541-544

Corresponding Author: Serdar Bozyel, Türkiye
Manuscript Language: English


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