Spiral atrial septal defects may complicate transcatheter closure and increase the risk of device embolisation. We describe a 5-year-old boy with pulmonary stenosis and a secundum atrial septal defect in whom an initially implanted 9 mm device embolised. At repeat intervention, balloon sizing revealed a bilobed, peanut-shaped configuration with a double waist, suggestive of a spiral atrial septal defect. A 15 mm device was subsequently implanted, achieving stable closure. The “Peanut Sign” may serve as a useful marker for identifying spiral atrial septal defects and guiding appropriate device selection.

Device embolisation is one of the most feared early complications of percutaneous atrial septal defect closure. We report a 40-year-old woman in whom a 12-mm atrial septal defect occluder was accidentally displaced into the descending aorta 24 hours after an apparently successful procedure. The dislodged device was retrieved percutaneously through a 12-F long sheath that was continuously railroaded over a super-stiff guide wire. This “retained super-stiff guide wire” technique secured sheath stability, avoided aortic wall trauma, and allowed the occluder to be slipped into the sheath without change of its orientation. A larger 16-mm small-waist–big-edge device was subsequently implanted uneventfully. The technical details and advantages of keeping the sheath constantly over a super-stiff guide wire are highlighted to facilitate safe trans-arterial retrieval of embolised cardiac devices.

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.