Fig. 3 One day after the procedure, the embolized Amplatzer device was seen in pulmonary artery (white arrow) on chest X-ray (A), which was lodged on right pulmonary artery ostium (white arrow) on transthoracic echocardiography (B). MPA: main pulmonary artery, … The operation was carried out with median sternotomy. After cardiopulmonary bypass, pulmonary Inhibitors,research,lifescience,medical artery was opened and the Amplatzer occlude was identified in the bifurcation site of pulmonary artery trunk. Some of the marginal tissue in inferoposterial portion of the atrial septum was composed with friable membranous tissue. After removing the thin and friable tissue, the

size of ASD was measured up to 30 × 40 mm. The ASD was closed using pericardial patch and she discharged from the hospital on the 5th postoperative day without other complications. Discussion Since the introduction in 1974, device closure of secundum type ASD is increasing and became an alternative to surgical treatment.3) Although immediate procedural success Inhibitors,research,lifescience,medical rate of Amplatzer septal occluder is 95-98%, adverse events including arrhythmia, cerebral embolism, cardiac tamponade and device embolization requiring immediate surgical removal can occur.4) Among them, device embolization is a potential life threatening complication requiring immediate removal via percutaneous or surgical intervention. Although the reported incidence is 0.01-0.55%, it would be higher in less INK 128 datasheet experienced operators.4-6) The Inhibitors,research,lifescience,medical common

reasons for the device embolization are undersized ASD Inhibitors,research,lifescience,medical device, small left atrium to accommodate the device, inadequate or floppy rim and operator-related technical issues.6) Most of the device embolization occurs during or several days after the procedures.4) Immediate embolization occurs in the procedural field and thought to be caused by malposition or incorrect device size. Undersizing of the device is the most common reason for the embolization in such case.6) However, subacute embolization within several days of the procedure is thought to be associated in large part with aortic rim erosion or floppy septum.7) In present case,

nearly Inhibitors,research,lifescience,medical absent aortic rim and large defect size (28 mm) could be one reason for device migration. However, large ASD size and the small or deficient aortic rim itself is not a contraindication and often considered as suitable Thymidine kinase for device closure with Amplatzer occluder.8),9) Another important reason for the device migration is thin and floppy membranous nature of posterial portion of the atrial septum which was confirmed in operation field. Combination of small aortic rim and floppy membranous nature of counterpart rim (inferoposterior rim) increased the instability of oversized Amplatzer device and may lead to migration and embolization of device in our patient. In case of complicated ASD, as our present case, it is often difficult to reconstruct the spatial structure with the use of two dimensional (2D) images.