Introduction: Transcatheter closure of a patent foramen ovale (PFO) or atrial septal defect (ASD) using devices like the Amplatzer septal occluder is a widely accepted treatment to prevent paradoxical embolism. Though typically safe, rare complications such as device embolization can occur, leading to life-threatening outcomes.
Methods: We present a case of delayed device embolization resulting in acute shunt physiology and hypoxemia. Data were collected via retrospective chart review, imaging analysis, and multidisciplinary consultation. A literature review was performed to contextualize findings.
Results: An 89-year-old female with CAD, diabetes, and a remote history of attempted PFO closure presented in septic shock with acute kidney injury and hypoxic respiratory failure. After initial stabilization and extubation, she developed new ECG changes and elevated troponin, prompting anticoagulation for NSTEMI. Persistent hypoxia led to CT angiography, which revealed an embolized Amplatzer device in the left pulmonary artery. Interventional Radiology and Surgery deemed her a poor candidate for retrieval. On day 4, she acutely decompensated with refractory hypoxia. A bubble study confirmed right-to-left shunting. The embolized device likely caused perfusion impairment and increased pulmonary pressures, unmasking or reopening a PFO. Despite maximal ventilatory support, she developed multiorgan failure and died after transitioning to comfort care.
Conclusions: Though rare, embolization of septal occluder devices can result in profound hypoxia due to shunt physiology. This case underscores the importance of high clinical suspicion, imaging, and multidisciplinary management in patients with prior device placement and unexplained hypoxia.
