Research Day
CLOSURE OF ATRIOVENTRICULAR CANAL PATCH DEFECT WITH AMPLATZER PFO OCCLUDER DEVICE
Document Type
Abstract
Date
2021
Abstract
Introduction: A patent foramen ovale (PFO) is a common embryologic defect with a prevalence of 25% with potentially catastrophic consequences from paradoxical emboli. While traditional surgically closed, patient outcome and satisfaction trials incentivize the development of novel percutaneous interventions. We present such a case utilizing an Amplatzer PFO occluder device to close an atrioventricular (AV) canal patch defect.
Case: A 57-year-old female with a remote history of a congenital AV canal defect, repaired at age 5, presented to the ED with symptomatic tachy-brady syndrome requiring dual chamber pacemaker implantation. Her clinical course was complicated with inadvertent placement of the right ventricular pacer lead through a defect in the AV canal patch into the left ventricle, which was discovered 2 months later when she presented with transient neurologic deficits. A brain MRI demonstrated multiple areas of subacute cerebral infarcts postulated as embolic phenomena from the inadvertent LV pacer lead. She underwent lead revision and subsequently percutaneous closure of the 8.4mm AV canal patch defect utilizing an 18mm Amplatzer PFO occluder device. Intracardiac echocardiography and fluoroscopy confirmed appropriate device positioning and on 2 year follow-up the patient remains asymptomatic.
Discussion: The location of the AV canal patch defect allowed deployment of the device without impairment of pulmonary venous return, stenosis of the superior vena cava, or entrapment of a pacer lead. Further, percutaneous intervention facilitated patient discharge one day post-procedure with minimal lifestyle restriction. Our case highlights a unique percutaneous technique which may offer treatment options for similar cases in the future.