Published online October 16, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1572-e1575 (doi:10.1542/peds.2005-0825)
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EXPERIENCE & REASON

Cardiac Perforation 6 Weeks After Percutaneous Atrial Septal Defect Repair Using an Amplatzer Septal Occluder

Michal S. Maimon, MDa, Savithiri Ratnapalan, MBBS, MEd, MRCP, FRCPC, FAAPa, Anh Do, MDa, Joel A. Kirsh, MDb, Gregory J. Wilson, MDc and Lee N. Benson, MDb

a Divisions of Emergency Medicine
b Cardiology
c Pathology, Hospital for Sick Children, Toronto, Ontario, Canada

ABSTRACT

A 14-year-old boy presented to the emergency department unaccompanied by his parents with a decreased level of consciousness, bradycardia, and hypotension after a syncopal episode. The patient's electronic chart revealed a percutaneous closure of a secundum atrial septal defect using an Amplatzer septal occluder (AGA Medical, Golden Valley, MN) 6 weeks before this presentation. An urgent echocardiogram revealed a moderate pericardial effusion, and 320 mL of fresh blood was evacuated by subxiphoid pericardiocentesis. The child underwent surgical exploration and was found to have a perforation in the superior-posterior aspect of the right atrium, which was corrected. The septal occluder was extracted, and the atrial septal defect was closed with a pericardial patch. This case illustrates a rare but life-threatening complication of percutaneous closure of atrial septal defect using an Amplatzer septal occluder and the importance of timely access to patient records when available history and physical examination are limited.

Key Words: Amplatzer septal occluder • cardiac perforation • tamponade • complication • electronic charting

Abbreviations: ASD, atrial septal defect

Accepted Jun 5, 2006.