Migrated VSD closure device

Case contributed by Dr Khalid Alhusseiny

Presentation

Pan-systolic murmur following percutaneous device closure of a ventricular septal defect (VSD).

Patient Data

Age: 13 months
Gender: Female
X-ray

Pre-operative radiograph shows cardiomegaly and mildly congested pulmonary vessels.

The left costophrenic angle is blunted suggestive of mild pleural effusion.

Nasogastric tube is seen in place.

X-ray

Post-operative radiograph shows a radio-opaque closure device seen overlying the right lower lung zone along the course of the right lower pulmonary vessels denoting dislodged / migrated closure device. The pulmonary vessels are more congested compared to the pre-operative radiograph.

Case Discussion

Migration or displacement of VSD closure device is a rare complication that requires surgical intervention to retrieve the displaced closure device and correct the residual VSD.

This patient was discovered to have a migrated closure device one day following its deployment on routine post-operative follow-up. The patient was having a persistent pan-systolic murmur for which echocardiography was done and revealed persistent VSD. Chest radiograph confirmed the migration of the closure device along the right lower pulmonary vessels.

The patient was planned for re-catheterization, device retrieval and re-closure of VSD. 

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