Percutaneous Retrieval of a Sequentially Embolized Amulet Device: From Mitral Apparatus to Aortic Arch.

BACKGROUND

We present a case of a left atrial appendage occlusion device placement complicated by device embolization to the mitral apparatus, left ventricle, and then aorta, which was successfully retrieved via a transcatheter approach.

KEY STEPS: The key steps are to use ultrasound and fluoroscopic guidance to visualize real-time location of a dislodged device, consider use of rapid pacing during retrieval to stabilize the device and protect the mitral valve, and have a multidisciplinary real-time plan for urgent surgical intervention if needed.

POTENTIAL PITFALLS: Potential complications of device retrieval include worsening mitral regurgitation during snaring, left ventricular outflow tract obstruction, entrapment in chordae tendineae, and aortic injury while pulling the device around the arch.

TAKE-HOME MESSAGES: Device embolization during or after left atrial appendage closure device placement is rare but can cause serious, life-threatening complications. Prompt recognition, multidisciplinary planning, multimodality imaging, and individualized retrieval strategies are essential. Migration may occur during both deployment and retrieval, posing risk of vascular injury, valvular damage, and arrhythmias. Percutaneous retrieval is feasible in select cases.