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European Heart Journal Advance Access originally published online on December 19, 2005
European Heart Journal 2006 27(13):1604; doi:10.1093/eurheartj/ehi698
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A late complication of a patent foramen ovale amplatzer occluder device

Mohaned Egred* and Lindsay Morrison

Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK

* Corresponding author. Tel: +44 151 293 2389; fax: +44 151 293 2354. E-mail address: m.egred{at}ctc.nhs.uk

A 33-year-old woman had an embolic event to her fifth leftfinger 1-week post-partum. An echocardiogram demonstrated a patentforamen ovale (PFO) and right-to-left shunt with coughing and Valsalva manoeuvre. Sheunderwent percutaneous closure of aPFO with a 25 mm Amplatzer PFO occluder device. No complications were evident post-operatively and echocardiographic findings were normal. Four years later she presented with an episode of left-sidedhemi-sensory disturbance with left facial and left arm numbness associated with dysphasia, suggesting a transient cerebral ischaemia. A head CT-scan and carotid ultrasound were normal. She was started on aspirin and referred for transoesophageal echocardiogram. This demonstrated a mobile, flame-shaped thrombus attached to the centre button of the left atrial disc of the PFO device (Panels A and B) with normal appearance of the device and the heart. She was started on warfarin and continued with aspirin and a repeat study 3 months later did not show the left atrial thrombus anymore (Panels C and D). Warfarin was stopped and she was continued on aspirin and remains well.

Percutaneous closure of PFO is becoming increasingly common. Of its reported complications, thrombus formation, particularly on the left side of the device, is especially feared. This is usually prevented by anticoagulation during the procedure and the administration of long-term antiplatelet treatment. Late thrombus formation has been reported up to the first 6 months after implantation. To our knowledge, this is the first documented case of a late left atrial thrombus following the closure of a PFO and may have important clinical implications with the increasing use of percutaneous closure devices.

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/13/1604    most recent
ehi698v1
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