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Three‐Dimensional Transesophageal Echocardiographic Guidance during Retrieval of an Embolized Percutaneous Atrial Septal Defect Closure Device

A 59-year-old man was brought to the cardiac catheterization laboratory for evaluation of an atrial septal defect (ASD) which was noted on a transthoracic echocardiogram (TTE) during workup for orthodeoxia-platypnea. Right heart catheterization prior to the procedure revealed a right atrial saturation of 64.5%, a left atrial saturation of 77.6% and a pulmonary vein saturation of 97.6%. A sizing balloon (30 mm diameter) was inflated across the ASD and resulted in normalization of peripheral arterial oxygen saturations, confirming significant right to left shunting. Based on the patient’s symptoms, size of the ASD, and normalization of peripheral arterial oxygen saturations with balloon occlusion, it was felt that shunt was significant and the ASD needed to be closed. A transesophageal (TEE) probe with 3D capability (3D, Vivid 7, GE Medical Systems, Milwaukee, WI, USA) was inserted to further assess the ASD and guide a percutaneous closure. The secundum ASD was well visualized by 3D and 2D TEE (Fig. 1A/Video clip 1A and Fig. 1B/Video clip 1B). The diameter of the ASD measured 12–13 mm by 2D TTE, and only a small amount of anterior and superior rim was present as well as a complex posterior rim. A 14 mm and 16 mm Amplatzer septal occluder (ASO, AGA Medical, Golden Valley, MN, USA) would not anchor securely on the rims of the ASD, and therefore, an 18 mm