Publication

Abstract : A 48-year-old lady presented with mild exertional dyspnoea. On evaluation, she was found to have a large ostium secundum atrial septal defect (ASD) with a deficient anterior rim with significant left-to-right shunt. She underwent percutaneous device closure of the ASD using a 34 mm Cera™ (LifeTech Scientific Co., Shenzhen, China) atrial septal occluder. She was discharged the next day after confirming position of the device and absence of residual shunt. She presented for follow-up at 3 months without any symptoms. Screening echocardiography unexpectedly revealed an embolized device in the right atrium (Panel A), which was alarmingly intermittently flipping across the tricuspid valve into the right ventricle (Panel B), and back again (Supplementary material online, Video S1). She was taken up for emergency surgery for device retrieval and surgical closure of the ASD (Panels C and D). She had an uneventful recovery and was discharged on the fourth postoperative day. We believe the risk factors for embolization in this patient were the presence of the large ASD with deficient anterior rim and large shunt, and the use of a large device. So periodic follow-up for the 1st year is advisable in all patients especially if risk factors for embolization are present.