3 DISCUSSION
Management of ASO embolizations has been previously described in the literature as single case reports and very few multicenter experiences have been reported1-5. Embolization sites can be the right atrium, right ventricle, pulmonary valve, tricuspid valve, and much less frequently, the LVOT2. The surgical technique performed in these cases is usually gentle direct retrieval of the deployed device through the mitral valve3. To our knowledge, this is the first reported case of a symptomatic ASO embolization to the LVOT requiring emergent surgical retrieval through a combined approach (right atrium and ascending aorta) because of device tangling with the mitral subvalvular apparatus.
Cardiac tamponade is a rare complication, ranging from 0.1% to 0.3%2. In our case, the perforation of the left ventricular free wall during percutaneous retrieval attempts induced the pericardial bleeding.
Although percutaneous retrieval of the device is effective in approximately 70% of the cases3, when the occluder is located at the LVOT and involves the chordae tendineae of the mitral valve, percutaneous retrieval must not be attempted to avoid damage of the leaflets, the subvalvular apparatus or the LV2-4.