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CASE20191115_018
STRUCTURAL HEART DISEASE - Congenital Heart Disease (ASD, PDA, PFO, VSD)
How to Manage a Dislodged Atrial Septal Defect Occluder
Wei-Chun Huang1, Cheng-Chung Hung1, Chin-Chang Cheng1, Guang-Yuan Mar1, Chun-Peng Liu1
Kaohsiung Veterans General Hospital, Taiwan1,
[Clinical Information]
- Patient initials or identifier number:
1987651
-Relevant clinical history and physical exam:
The patient is a case of atrial septal defect for years. However, he suffered from dyspnea recently. Therefore, He visited our OPD.  TEE revealed atrial septal defect. Coronary angiography showed normal coronary artery. 
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-Relevant test results prior to catheterization:

- Relevant catheterization findings:
We planned to deliver ASD occluder. Balloon was used to size the ASD. However, it is difficult to deliver ASD occluder. During manipulation, the occluder was dislodged to left atrium.
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[Interventional Management]
- Procedural step:
We tried to use forceps to get the dislodge occluder out in left atrium. However, the occluder further dislodged to left ventricle. Therefore, we used snare to grasp the tip of occluder. Then, we could draw the dislodged occluder to ascending aorta and to Right femoral artery. At this moment, balloon assisted method was used to deliver another occluder in ASD site. After testing the stability of occulder, the occluder was released and delivered successfully. After the procedure, we consult cardiac surgeon and the dislodged occluder was removed via vessel cutting method.
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- Case Summary:
This is an interesting educational case. The dislodged occluder in ASD intervention happened occasionally. However, it is diffuclt to remove the dislodged occluder, especially in left ventricle. We used multidisciplinary method to remove the dislodged occluder successfully and prevented the patient suffered from risk of open heart surgery. 
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