3 DISCUSSION
Management of ASO embolizations has been previously described in the
literature as single case reports and very few multicenter experiences
have been reported1-5. Embolization sites can be the
right atrium, right ventricle, pulmonary valve, tricuspid valve, and
much less frequently, the LVOT2. The surgical
technique performed in these cases is usually gentle direct retrieval of
the deployed device through the mitral valve3. To our
knowledge, this is the first reported case of a symptomatic ASO
embolization to the LVOT requiring emergent surgical retrieval through a
combined approach (right atrium and ascending aorta) because of device
tangling with the mitral subvalvular apparatus.
Cardiac tamponade is a rare complication, ranging from 0.1% to
0.3%2. In our case, the perforation of the left
ventricular free wall during percutaneous retrieval attempts induced the
pericardial bleeding.
Although percutaneous retrieval of the device is effective in
approximately 70% of the cases3, when the occluder is
located at the LVOT and involves the chordae tendineae of the mitral
valve, percutaneous retrieval must not be attempted to avoid damage of
the leaflets, the subvalvular apparatus or the LV2-4.