Embolization of an Amplatzer atrial septal closure device to the pulmonary artery.

A 44-year-old woman with a history of transient ischemic attack underwent closure of atrial septal defect with a 26 mm Amplatzer device. The device was released without residual shunt or impingement on intracardiac structures. Within seconds, the transesophageal echocardiography showed the initial dislodgement of the device from the atrial septum and its consequent slipping back into the right atrium close to the tricuspid valve. Soon after the device disappeared from the right atrium and it could be founded into the right ventricle under the tricuspid valve. The patient was transferred in the operating room for an emergency operation. The device could not be found in the right ventricle because its downstream migration. The Amplatzer septal occluder was identified by palpation into the pulmonary artery trunk: it was retrieved from the right ventricle through the pulmonary valve and the atrial septal defect was closed by running suture.

Limitations and discrepancies of transthoracic and transoesophageal echocardiography compared with surgical findings in patients submitted to surgery for complications of infective endocarditis.

OBJECTIVE: Transoesophageal echocardiography (TEE) is recognized to be superior to transthoracic echocardiography (TTE) in evaluating complications of infective endocarditis (IE). The aim of this study was to compare results from TTE and TEE with surgical findings, and to assess limitations and discrepancies of TEE as compared with surgical findings. METHODS: A retrospective analysis was carried out in 63 consecutive patients undergoing surgical intervention for IE-related complications. All patients were submitted to TTE and TEE before surgery. Clinical, anaesthesiological and surgical data were reviewed for all patients as well as the TTE and TEE examinations recorded on S-VHS videotape. Patients were divided into two groups according to the time elapsed from TEE to surgery (> 72 h in group A and < 72 h in group B). RESULTS: The study population included 44 patients with native valve endocarditis and 19 patients with prosthetic valve endocarditis for a total of 76 affected valves (54 native and 22 prosthetic valves). No significant differences were observed between groups in number of patients (31 vs. 32; P = NS), of native valves (29 vs. 27; P = NS), and of prosthetic valves (10 vs. 12; P = NS). Discrepancies between TEE and surgical findings were found in 14 cases (11/31 in group A vs. 3/32 in group B; P = 0.01). CONCLUSIONS: Time between TEE and surgery seems to be an important factor affecting comparison. Lesion characteristics appear to be more precise and concordant with surgical findings the shorter the time elapsed from TEE to surgery. Changes resulting from disease progression require repeat TEE evaluation prior to surgical intervention for IE-related complications. This could be useful in providing the surgeon with a more accurate definition of valvular lesions for optimal planning of intervention.