Late erosion of Amplatzer Septal Occluder device 9 years after the implantation: a case report.

Cardiac erosion is a rare but life-threatening complication after the interventional closure of an atrial septal defect. We present the case of a patient who developed cardiac erosion 9 years after the placement of an Amplatzer Septal Occluder. The patient presented to our hospital with symptoms of tamponade. Surgical exploration revealed a tear in the roof of the left atrium. To our knowledge, this is one of the most delayed presentations reported. In these cases, diagnosis is difficult and a level of clinical suspicion is demanded.

Risk Factors and Predictors of Cardiac Erosion Discovered from 12 Japanese Patients Who Developed Erosion After Atrial Septal Defect Closure Using Amplatzer Septal Occluder.

Cardiac erosion is a rare serious complication following Amplatzer septal occluder (ASO) placement for atrial septal defect. Although multiple risk factors have been found, a useful predictor to prevent it has not been established yet. In 12 patients who developed erosion between 2005 and 2016 in Japan, we retrospectively observed patients' characteristics and transesophageal echocardiography findings immediately before and after ASO placement and at erosion onset. We compared risk factors of erosion, including absent aortic rim, device size/body weight ratio, device shape, or Valsalva sinus wall deformation pressed by either disk-edge, the maximum depth of which from the standard curve of the Valsalva wall was defined as Dent, between the 12 patients and 95 patients with Valsalva sinus wall deformation immediately after placement who did not develop erosion for 5 ± 3 years. Of the 12 patients, nine developed pericardial effusion with eight cardiac tamponade and three aorta-atrium fistula; all were surgically rescued. Surgical findings revealed that erosion in all patients occurred at the right and/or left atrial roof beside the Valsalva in the non-coronary cusp on which the disk-edge seemed to be pressing. The mean Dent immediately after the placement in patients with erosion was significantly deeper than without (2.48 ± 0.32 vs. 1.28 ± 0.38; p < 0.001). There were no differences in the other risk factors between the two groups. Dent is believed to be a useful indicator of erosion development after ASO placement. If Dent is > 2.0 mm, it is desirable to change the size or to replace the device.

Three-dimensional echocardiographic demonstration of aortic wall erosion after percutaneous atrial septal defect closure.

Although late complications of percutaneous closure of atrial septal defect (ASD), including cardiac erosion and thrombosis, are rare, they are the most lethal. Data are still lacking regarding the usefulness of new imagining modalities, such as three-dimensional echocardiography (3DE), for the detection of these complications. Here, we report the case of a 57-year-old woman in whom cardiac erosion was very well visualized by 3D transesophageal echocardiography (3D TEE) after percutaneous ASD closure.

Cardiac erosion after transcatheter closure of atrial septal defects / 中国介入心脏病学杂志

Objective To investigate the characteristics,occurrence times and management of cardiac erosion after transcatheter closure of ASD,and to discuss the mechanism and predictive factor of erosion.Methods We analyzed all the cases who received transcatheter ASD closure from September 1997 to September 2016 in our hospital retrospectively.Results 9 cases (9/6903,0.13％) were reported to have cardiac erosion events after device closure ASD of including 2 cases of acute cardiac tamponade needed pericardiocentesis,2 cases of aorta-to right-atrial fistula needed transcatheter closure or operative repair and 5 cases of perforation of the anterior leaflet of mitral valve.1 case with MV anterior leaflet perforation presented with hemolysis and required surgical repair.Cardiac erosion events were found at average 52.9±68.3 days (1-180days) after the ASD closure.Conclusions Cardiac erosion is a rare but serious complication of device closure for ASD.Erosion events are mostly attributed to device over-sizing or deficient retro-aortic rims.It is important for a strict follow-up,early deduction and timely disposition when an erosion event is identified.occurring.