# Successful Percutaneous Extraction of a WATCHMAN FLX Device From the Left Ventricular Outflow Tract

## TL;DR

A rare case of a medical device moving to the wrong heart area was successfully removed using a new minimally invasive technique.

## Contribution

A novel percutaneous extraction technique using rat tooth/alligator forceps for retrieving a migrated WATCHMAN FLX device from the LVOT.

## Key findings

- Device migration to the left ventricular outflow tract was incidentally detected in a 77-year-old patient.
- Percutaneous extraction using a transaortic approach successfully retrieved the device without surgery.
- The technique reduced hospitalization length and surgical risks in this case.

## Abstract

Although rare, embolization of left atrial appendage occlusion (LAAO) devices carries a significant morbidity and mortality burden.

An asymptomatic 77-year-old woman with inability to tolerate anticoagulation due to gastrointestinal bleeding presented for 45-day transesophageal echocardiography following LAAO with a Watchman device, which demonstrated incidental device migration to the left ventricular outflow tract (LVOT). Percutaneous extraction was performed using a novel technique with rat tooth/alligator forceps to successfully retrieve the Watchman from the LVOT using a transaortic approach.

LAAO device embolization is a rare, yet serious, complication. Retrieval from the LVOT is typically performed with cardiac surgery to avoid damage to the mitral valve. This case demonstrates that percutaneous Watchman device retrieval from the LVOT is technically challenging but can be safely performed in select cases to decrease the length of hospitalization and morbidity associated with surgery.