Miniinvasive hybrid procedure for device migration after percutaneous closure of persistent arterial duct: a case report

We report a case of an 8-month-old girl admitted to the Department of Paediatric Cardiac Surgery, Pomeranian Centre of Traumatology in Gdansk with migration of an Amplatzer Duct Occluder II device (AGA Med. Corp., USA) to the left pulmonary artery after interventional patent arterial duct (PDA) closure. Using a hybrid strategy, we performed a classical surgical closure of the PDA with simultaneous intraoperative miniinvasive catheter removal of the displaced implant from the left pulmonary artery using a muscle bioptome (Cook, EU). The procedure was successful, without any further complications. Percutaneous procedures of PDA closure in small children, although safe and effective, are associated with a risk of accompanying complications, especially in patients with inconvenient anatomy. Our strategy demonstrates that a miniinvasive hybrid strategy could be beneficial for the patient with implant PDA migration after a failed interventional procedure. We strictly maintain the practice of qualifying these borderline patients with great care to avoid predictable complications, and to provide immediate surgical support in any emergency, following modern models of cooperation between cardiologists and cardiac surgeons in hybrid heart teams. A modern strategy that combines miniinvasive cardiac surgery with interventional techniques provides new, effective algorithms for selective difficult clinical settings.