Complete Percutaneous Retrieval Of Migrated VSD Occluder Device From The Pulmonary Artery: Management Of A Catastrophic Complication

Transcatheter closure of muscular ventricular septal defect (VSD) remains a safe and effective method with low complication rates. However, device migration can pose a great challenge to interventional cardiologist regarding mortal consequences. A 21-year-old female presented to our clinic with exertional dyspnea and diagnosed with muscular VSD. The defect was percutaneously closed using an Amplatzer occluder device. On the first post-procedural day, the patient suffered from repeated episodes of coughing and mild hemoptysis. Imaging revealed migrated VSD occluder device to the right pulmonary artery (PA) and percutaneous retrieval of the device was decided. The right PA was reached with a hydrophilic guidewire and pigtail catheter. Then the catheter was exchanged with an 8-Fr sheathless guide catheter and a 6-Fr Judkins right catheter was advanced into the right PA through sheathless guide catheter using mother and child technique. Multiple attempts using the snare were made to retrieve the migrated device. Eventually, proximal marker point, hub of the device was grasped and pulled back from the PA and externalized through the sheath without need of surgical cutdown. Our report represents a case of complete percutaneously retrieval of embolized VSD occluder device to the PA.