Open Retrieval of an Embolized Septal Occluder From the Aortic Arch.

BACKGROUND: Embolization of septal occluder devices is an uncommon complication of transcatheter atrial septal defect closure. Delayed recognition with chronic retention in the aortic arch is rare and presents complex management considerations. CASE SUMMARY: A 37-year-old woman with prior transcatheter secundum atrial septal defect closure was found on follow-up imaging to have an absent intracardiac occluder device. Computed tomography demonstrated embolization to the distal aortic arch near the origin of the left subclavian artery. Although asymptomatic at diagnosis, the device location, chronicity, residual atrial-level shunt, and suspected intimal incorporation favored operative management. She underwent open surgical retrieval under cardiopulmonary bypass with lower-body circulatory arrest and antegrade cerebral perfusion, with concomitant septal defect repair. DISCUSSION: Open surgical retrieval allowed controlled device removal, assessment of aortic wall integrity, and definitive repair of residual shunting when endovascular retrieval options were limited. TAKE-HOME MESSAGES: Delayed recognition of septal occluder embolization should prompt careful evaluation of device location, chronicity, incorporation, embolic risk, and feasibility of endovascular retrieval. In selected patients, open surgical retrieval enables controlled device removal, assessment of aortic wall integrity, and concomitant repair of residual atrial-level shunting.