Late Device Detachment Following Percutaneous Atrial Septal Defects Closure: A Robotic Surgical Rescue.

BACKGROUND

Percutaneous closure of atrial septal defects (ASDs) is widely performed, but late device detachment is rare and underrecognized. Multimodality imaging is crucial to aid in diagnosis and further procedural planning, especially more novel robotic repair.

CASE SUMMARY: A 36-year-old woman with a history of thalassemia minor presented with progressive dyspnea and chest pain 9 months after percutaneous ASD closure. Cardiac computed tomography and transesophageal echocardiographic imaging revealed device detachment from the superior and anterior rims with left-to-right shunting. She underwent successful robotic surgical explantation and ASD patch repair with resolution of symptoms.

DISCUSSION: Few reports describe robotic removal of ASD occluder devices. This case highlights delayed device detachment in the setting of deficient rims and the utility of multimodality imaging for diagnosis and surgical planning. It demonstrates the feasibility of a robotic approach for device retrieval and defect repair, offering a minimally invasive alternative to sternotomy.

TAKE-HOME MESSAGES: Delayed ASD device detachment may present subtly and warrants thorough imaging follow-up. Robotic explantation is a safe, effective alternative in selected cases.