Hybrid Transcatheter and Endoscopic Retrieval of a Pulmonary Artery-Embolized ASD Occluder in Hemodynamic Compromise.

BACKGROUND

Embolization of atrial septal defect (ASD) occluders is uncommon but potentially life-threatening, often requiring urgent intervention. Transcatheter retrieval is typically attempted first, but success depends on achieving slenderizing of the device-which may be limited by anatomy or device position, frequently necessitating surgical removal.

CASE SUMMARY: A 25-year-old woman presented with hemodynamic compromise after embolization of an ASD occluder into the main pulmonary artery. A tailored hybrid strategy was undertaken: controlled snare-guided mobilization of the device into the right ventricle created a surgically accessible position, enabling minimally invasive 3D-endoscopic extraction and definitive ASD repair, avoiding sternotomy and pulmonary arteriotomy.

DISCUSSION: This case represents the first reported hybrid combination of transcatheter approach with minimally invasive endoscopic cardiac surgery for pulmonary artery-embolized ASD occluder retrieval, highlighting the importance of interdisciplinary, cross-subspecialty procedural planning.

TAKE-HOME MESSAGE: Hybrid transcatheter-endoscopic approaches may be a feasible, least-invasive retrieval and repair strategy when standalone transcatheter retrieval is unsuccessful.