Late complication after transcatheter closure of an atrial septal defect

The transcatheter closure of atrial septal defects is generally accepted as an alternative to surgical therapy in selected patients. Potential complic ations of these devices are a matter of concern, as well as the very compli cated implantation technique required for some systems. We report on a 17 year old patient in whom embolization of a fractured umbr ella arm into a peripheral branch of the left pulmonary artery occurred. A 35 mm-ASDOS-Device (protected trademark of the Dr. Osypka GmbH/Grenzach-Wyh len, Germany) had been implanted 4 years ago. The perfusion scintigraphy of the left lung showed normal pulmonary blood flow. Echocardiography failed to demonstrate instability of the double-umbrella device. The patient was a lways free of any symptoms. Due to the permanent stresses between device and heart, late fractures of t he device and embolizations of fragments are possible. It can be concluded that patients who underwent transcatheter closure of an ASD require lifelon g follow-up.