Retrieval of Malpositioned Atrial Septal Occluder (ASO) Devices: Call for Guidelines

Excerpt

Device closure has become the treatment of choice for managing uncomplicated septal defects in paediatric population. More and more atrial septal defects (ASD) are closed by Atrial Septal Occluder (ASO) devices each year, and this number is likely to increase in the years to come. As with any intervention, the number of complications associated with it also would increase in a parallel fashion. One of the most feared complications of ASD device closure is device malposition, incidence of which ranges between 0.5 and 2 %, occurring as a result of faulty technique or because of insufficient rims [1]. Technical failure is rarely an issue owing to quick learning curves particularly for ASD. Though most of the cardiologists believe that transoesophageal echo is needed for detailed assessment of the rims and to ensure delivery safety [2, 3], very few do it actual reason being the child needs nothing short of general endotracheal anaesthesia that too in a remote environment like cath lab. Some centres even do TEE under sedation taking the risk of increase in intrathoracic pressure and dislodgement of the device if the child coughs unlike adults who tolerate the TEE probe better especially if they are psychologically prepared and motivated. Even though one can claim that deeper levels of sedation can been used to make the child comply with the TEE probe, it is not recommended as respiratory depression and build up of carbon dioxide can further increase PA pressures and cause pulmonary hypertension which might enhance device dislodgement [4]. …