Successful Surgical Intervention of a Complication that Occurred During Transcatheter Atrial Septal Defect Closure

Abstract

Atrial septal defect (ASD) is the most common congenital heart disease diagnosed in adults, with an average life expectancy of 45–50 years in affected individuals. Surgical intervention is typically indicated when the pulmonary-to-systemic blood flow ratio (Qp/Qs) exceeds 1.5:1. A 44-year-old patient with a known diagnosis of Behçet’s disease presented to the cardiology outpatient clinic 6 years ago with complaints of palpitations and was diagnosed with an ASD. Since then, the patient has been under regular follow-up by the cardiology department. A transesophageal echocardiogram revealed a Qp/Qs ratio of 1.8:1. Given the patient’s ongoing symptoms of heart failure, percutaneous closure of the defect was planned. The patient was referred to the cardiac catheterization laboratory for endovascular ASD closure. During the procedure, a small fragment of the closure device broke off and became lodged beneath the aortic valve. Multiple attempts were made to retrieve the fragment using a trapping system, but they were unsuccessful. The patient was promptly transferred to the emergency cardiovascular surgery team. The foreign body was successfully removed via a transaortic approach, and the ASD was closed through a right atriotomy. While endovascular closure is generally recommended for patients at high surgical risk, it has increasingly been used in younger patients with stable clinical conditions. Although it is associated with lower complication rates compared to open-heart surgery, technical and device-related complications may still occur unpredictably.

Cite This Article: Guseinov Z, Topcu SM, Bayraktar FA, Kocaaslan C, Aydın E. Successful Surgical Intervention of a Complication that Occurred During Transcatheter Atrial Septal Defect Closure. Koşuyolu Heart J 2025;28(3):140–142.