Role of an Anaesthesiologist in the Management of an Embolised ASD Closure Device - Journey from Cathlab to OT

ABSTRACT

Percutaneous device closure of Atrial Septal Defect (ASD) is a commonly used technique as an alternative to surgery with advantages of avoidance of sternotomy, short hospital stay, and fewer complications. However, it may lead to life-threatening complications such as device embolization. We here, report such a case of embolization of the ASD occluder device causing right ventricular inflow obstruction and severe cardiopulmonary compromise. The anaesthesiologist plays the role of a team leader in diagnosing and managing such an emergency from cath lab to transfer of the patient till the retrieval of the device and discharge of the patient.Atrial septal defect is one of the commonest congenital heart diseases (3.78 / 10000). Shunts from ASD are detected in childhood or young adulthood and are well tolerated in infants and young children, but symptoms of mild fatigue, poor growth or dyspnoea on exertion may be present.(1) Thus, early closure should be considered in such infants. If the defect is small, it may not require any intervention. The shunt, tends to increase with age, and repair is required when ASD is diagnosed.1 Patients with huge defect closure to be done between 2 - 5 yrs. Total intravenous anaesthesia or MAC (Monitored Anaesthesia Care) is given in maximum interventional cardiology procedures as patient is required to stay still for up to 1 hr.2 Percutaneous transcatheter closure of the defect is most frequently done for ASD closure.3,4 It avoids the need for surgery, and is related to few complications.3,5 However, complications such as cardiac perforation, fistula formation, thrombosis, arrhythmia (2.6 %) device dislodgement (3.5 %) both to the systemic and pulmonary circulation.6 They may lead to haemodynamic compromise, inflow or outflow obstruction, which calls for immediate retraction. This is a case of right ventricular inflow obstruction due to embolised closure device.