Closure of all haemodynamically significant atrial septal defects (ASDs) is recommended irrespective of symptoms. Percutaneous device closure offers a favourable alternative to surgery with lower morbidity, shorter duration of hospital stays, and avoidance of a surgical scar. Though device closure is generally a safe procedure with high success rates, certain complications can arise including device embolization which poses a significant challenge for the treating team. We report one such case in which the ASD closure device got spontaneously released and embolized from the delivery cable into the left atrium prior to its deployment. We describe our approach for its retrieval and subsequently its successful deployment across the septal defect using a gooseneck snare. A 5-year-old asymptomatic child was found to have a murmur on a routine check-up. Evaluation revealed a haemodynamically significant, 18-mm ostium secundum ASD with normal pulmonary pressures and suitable margins for device closure. A 20-mm ASD closure device was traversed via an 8-Fr delivery system. While manipulating the left atrial (LA) disc from the right upper pulmonary vein (RUPV) approach, the device got spontaneously released. The right atrial (RA) disc was caught across the ASD, into the left atrium. This was confirmed by intraoperative transthoracic echocardiography and fluoroscopy. The haemodynamics and rhythm were stable. A 20-mm gooseneck snare was immediately passed through the delivery sheath and an attempt was made to catch the screw. With difficulty, the RA screw was caught with the snare and multiple attempts to retrieve the device into the sheath were unsuccessful. However, while negotiating, we were able to secure a favourable position of the device across the atrial septal defect, and after fluoroscopic and echocardiographic confirmation, the device was released. The child remained stable thereafter and was discharged 2 days later. Gooseneck snare is a valuable tool in the management of embolized ASD closure device. Occasionally, like in the index case, one may be successful in retrieving the embolized device and repositioning it across the ASD using a gooseneck snare, thus obviating the need for emergency surgery.

中文翻译：

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使用鹅颈圈套器取出和重新定位栓塞的房间隔缺损闭合装置

无论症状如何，建议关闭所有血流动力学显着的房间隔缺损 (ASD)。经皮装置闭合提供了一种有利的替代手术方法，具有较低的发病率、较短的住院时间和避免手术疤痕。虽然装置闭合通常是一种成功率高的安全手术，但可能会出现某些并发症，包括装置栓塞，这对治疗团队构成了重大挑战。我们报告了一个这样的案例，其中 ASD 闭合装置在部署之前自发地从输送电缆释放并栓塞到左心房。我们描述了我们的修复方法，随后使用鹅颈圈套器成功部署到隔膜缺损处。一名 5 岁无症状儿童在例行检查中被发现有杂音。评估显示存在血流动力学显着的 18 毫米继发孔 ASD，肺压正常，装置闭合边缘合适。20-mm ASD 闭合装置通过 8-Fr 输送系统穿过。从右上肺静脉 (RUPV) 入路操纵左心房 (LA) 椎间盘时，该装置自发释放。右心房 (RA) 椎间盘穿过 ASD，进入左心房。术中经胸超声心动图和透视证实了这一点。血流动力学和节律稳定。一个 20 毫米的鹅颈圈套器立即穿过输送鞘并试图抓住螺钉。困难的是，RA 螺钉被圈套器卡住，多次尝试将装置收回鞘中均未成功。然而，在谈判过程中，我们能够确保设备在房间隔缺损的有利位置，在透视和超声心动图确认后，设备被释放。此后孩子病情稳定，2天后出院。鹅颈圈套器是管理栓塞 ASD 闭合装置的宝贵工具。有时，就像在指示病例中一样，使用鹅颈圈套器可以成功取回栓塞装置并将其重新定位在 ASD 上，从而避免了急诊手术的需要。