Left Atrial Thrombus on Atrial Septal Defect Closure Device as a Source of Cerebral Emboli 3 Years After Implantation

Abstract

A 55-year-old man presented with sudden occurrence of recurrent transitoric ischemic attacks with dysphasia and paresis of the left side in May 2004. Other than these symptoms, he presented in good physical condition, with no cyanosis or edema, and his ECG showed regular sinus rhythm at normal rate. Chest x-ray and laboratory studies were unremarkable. He was not taking medication.His medical history consisted of a patent foramen ovale (PFO) that had been closed 3 years earlier with the CardioSeal/Starflex Occluder (33 mm). The PFO was diagnosed because he had presented at the hospital with headache and vertigo. The CT scan of the head showed a small anterior inferior cerebellar infarction with no evidence of tumor or bleeding. Subsequent echocardiography revealed a PFO, and the patient was referred for implantation of the atrial septal defect (ASD) closure device. The immediate postprocedural medication of our center for this device included antiplatelet therapy with aspirin 300 mg daily for 6 months. At 2-year routine follow-up, the patient was doing well, with excellent physical exercise capacity and no neurological symptoms.

Patent Foramen Ovale Using the Premere Device: The Results of the CLOSEUP Trial

“…Although thrombus disappeared or markedly diminished after additional anticoagulation therapy in three patients, one patient had surgical explantation of the device due to progressive increase in the size of thrombus with hypermobility despite intensive anticoagulation therapy 12 . Finally, in a recent case report, Ruge et al report a left atrial thrombus on a Starflex device 3 years after implantation 13 . In the CLOSEUP study, where transesophageal echocardiograms were performed that included a detailed examination of the left atrial anchor for evidence of thrombus, no patients were found to have device related thrombus at any time.…”

A suture not always the ideal solution: Problems encountered in developing a suture‐based PFO closure technique

“…Despite the benefits of these devices, there remains the potential disadvantage of large foreign material in the atria. Potential complications associated with PFO implant devices include thrombus formation [18–20], device erosion [21–23], and atrial fibrillation [24–26]. Another disadvantage seems to be that these devices may obstruct transeptal access to the left atrium and preclude the treatment of acquired heart disease such as percutaneous heart valve repair and replacement, left atrial appendage closure, and arrhythmia intervention.…”

Secundum atrial septal defects: time to close them all?

“…Complications include device embolisation, cardiac perforation, device thrombus, stroke, arrhythmia and serious vascular injury. These types of complication, together with device failure, may require conversion to open surgery either immediately, or at a later date 5 – 9. Recent data suggest that late valve problems may also occur 10.…”