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It was reported that on (b)(6) 2026, a 18mm amplazter septal occluder was chosen for implant using an 8f amplatzer torqvue delivery system for a closure of a post-infarct ventricular septal defect (vsd) in a patient who had experienced a myocardial infarction approximately 10 days earlier.During the procedure, the left disc of the occluder was deployed in the left ventricle as intended.However, transesophageal echocardiography (tee) imaging was limited due to interference attributed to an impella pump positioned in the aorta, resulting in difficulty visualizing and guiding the device to an optimal position.It was stated that the physician elected to recapture the left disc and attempt redeployment closer to the ventricular septum.Upon redeployment, the left disc formed a ¿cobra head¿ configuration.The deformed device was never released from the delivery cable.There was no interaction with the cardiac structures during deployment and no angulation/kink were noticed in the delivery system.The device was then recaptured and removed without incident.Because the delivery sheath remained positioned across the defect within the left ventricle, the physician exchanged and upsized the delivery system to a 9f amplatzer trevisio delivery system and selected a 17mm amplatzer septal occluder.When advancing this second device, the left disc again assumed a cobra head configuration and the device had some interactions with the mitral leaflets.The physician subsequently recaptured and redeployed the disc two additional times.It was then reported that tee imaging demonstrated a developing pericardial effusion.During the procedure the patient¿s activated clotting time (act) was above 250 and had a sinus rhythm.Pericardial effusion was noted on the outside of atriums.The pericardial effusion was localized near atria and the physician believes it might have been due to recapturing and re-deploying the device multiple times near the lv apex.Pericardiocentesis was performed, and although fluid was initially drained, reaccumulation was observed.Based on these findings and concern for a possible perforation, the physician recommended transferring the patient to surgery for vsd repair.
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