Technical Report: Beijing Tiantan Hospital Resolves Complex PFO Occluder Complication

Case Overview Recently, the Center for Cardiac and Vascular Diseases at Beijing Tiantan Hospital, in collaboration with the Department of Echocardiography, successfully performed a highly complex secondary intervention on a 58-year-old female. The procedure resolved a complex complication of "incomplete degradation with residual shunt" following a biodegradable PFO occluder implantation performed at another institution.

Clinical Dilemma The patient suffered from recurrent cerebral ischemic events post-implantation. Imaging (TEE + CTA) confirmed the presence of unstable, incompletely degraded tissue on the left atrial side of the septum, accompanied by a residual shunt. The patient faced a dual threat: direct embolism from tissue dislodgment and paradoxical embolism via the shunt. With conventional antithrombotic therapy failing and open-heart surgery posing prohibitive risks, a secondary transcatheter intervention became the crucial therapeutic option.

Surgical Execution & Technical Details Facing a dense central core up to 12 mm thick and highly friable surrounding residual tissue, the surgical team adopted a targeted interventional pathway:

▪️ Echo-Intervention Integration: Under real-time TEE guidance, the team bypassed the fragile tissue and precisely punctured the densest central zone of the original occluder to establish access. ▪️ Dual Goals in a Single Step: A conventional nitinol occluder was deployed. Utilizing its double-disk clamping force, the team performed a "sandwich-style" clamping reconstruction of the atrial septum and the residual tissue. This maneuver simultaneously achieved physical closure of the residual shunt and stable anchoring of the high-risk free tissue.

Clinical Value & Conclusion Postoperatively, the patient's cerebral ischemia and migraine symptoms improved significantly. This case demonstrates that for the novel complication of "incomplete degradation with residual shunt" following biodegradable occluder implantation, a "central approach combined with transcatheter clamping" strategy can simultaneously achieve free tissue fixation and shunt occlusion without the need for open-heart surgery. It provides a highly valuable interventional reference pathway for managing potential long-term complications associated with biodegradable materials.