#Discussing_the_tough_part #Complications 38mm ASD DEPLOYED satisfactory , dislodged after 2 hours in CCU .. Tried best but cud not be removed percutaneously .. Surgical removal of device and Closure was done uneventfully .. #Tough_part 1. How to bounce back the confidence of doing complex procedures when this happen ?... 2. What more additional device or hardware / technique was needed to retrieve it percutaneously or surgery itself is the only answer .. kindly show ur embolized cases and how they were managed as to manage better next time .. SREEVATSA NADIG DM FSCAI FESC Ankur Phatarpekar Abdelkader Almanfi, MD, FACC, FSCAI akbar haq Jack Hall Bilal Iqbal Sripal Bangalore Khaled AlShaibi Wail AlkashkariFSCAI,FPICSوائل القشقرى🇸🇦🇨🇦🇺🇲 MIЯVΛƬ #IC ༄ ｡° jedicath աǟզǟʀ.ǟɦʍɛɖ Dr . $@ndeep K@m@t Dr G Rajesh (Gopalan Nair Rajesh). Joy Sanyal,MD, DM, Dr. Sameer Gupta Khalid Minhas, MD FACC Hany Ragy Dr Imran Hanif Hashmi Arvin Narula PCRonline 🫀 Salman Arain Rajesh VIJAYVERGIYA Somalaram Venkateshshow more

@MatthiesenTimm In such a huge defect I would consider surgical closure upfront.

We don't have to hurt anymore

Complications happens. Important to stand still and never leave your patient behind. Important to have good backup surgeons by your side.

It is reassuring that you are taking this personally and seriously. I don’t do ASD closure nowadays, but there must have been a reason why it embolized - not necessarily a predictable one. Here are some general thoughts: 1. Complications happen - they keep us grounded. 2. Sending a patient to surgery is not a defeat - but causing the patient harm by not realizing that you are out of percutaneous options definitely is. 3. Complications are an opportunity to learn new things - retrospective review and analysis is important. 4. If you haven’t had a complication, then you probably are doing enough cases of that type. (The opposite is not true though!)

Retrospectively- although the minnesota wiggle looks good-in LAO cranial- it does seem some part of LA disc hs already prolapsed in RA We also hd a similar case which needed surgical retrieval.Did one device recently where inadvertently there ws a LA rent and tamponade 1/2

This was a bit everted look AK sir.

Retweeting this as original disappeared TEE is crucial.

Yup .. Any tricks on percutaneously retrieving ?

These type retrivial devices may help otherwise you have to catch it by trial and error and pushing embolised device at somewhere more stable less floating in vasculature may ease the retrivial procedure..

As anaesthesiologist I wonder if ventilatory pressure might have a role. Positioning under general anesthesia and positive intrathoracic pressure and embolization when patient is back to spontaneous breathing. Did it happened before or after extubation?

Patient was not intubated , procedure was being done in LA as is usually done for most cases in my lab