Page 39 - Journal of Structural Heart Disease Volume 5, Issue 6

Case Report
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:263-267
DOI: https://doi.org/10.12945/j.jshd.2019.005.19
Received: February 07, 2019 Accepted: February 20, 2019 Published online: December 2019
Very Late Thrombosis of an Atrial Septal
Defect Occluder Device Causing a Massive
Splenic Infarction
Pablo Tome Teixeirense, MD*, João Felipe Barros de Toledo, MD, Luiz Antonio Gubolino, MD, Antoninha Azevedo Bragalha, MD, Camila Alves Pereira, MD
Interventional Cardiology, Incorpi - Hospital dos Fornecedores de Cana de Piracicaba, Piracicaba, Sao Paulo, Brazil
Percutaneous occlusion of atrial septal defect (ASD) has emerged as the first approach of treatment in many cardiac centers, because of lower post-procedure mor- bidity and shorter hospital stay when compared to open-heart surgery. However, there is scarce informa- tion on very late complications.
We present a case of a 19-year-old girl who had a very late systemic thrombotic complication. The pa- tient was treated six years before, with the implant of an Occlutech® Figulla® (Helsinborg, Sweden) 33mm de- vice for closing a secundum ASD. The implant was guid- ed by a 2D transoesophageal echocardiogram.
There were no complications during the procedure. The patient was oriented to take DAPT for 6 months after the procedure, but she decided not to take any medication. Interestingly, there were no thrombotic complications during the first six years follow-up.
The Echocardiograms performed at one (TTE), six (TTE) and twelve months (TOE) after the procedure showed a well-implanted device and no residual shunts.
Six years after the procedure, the patient was taking only contraceptive therapy. She has begun abdominal pain of subtle onset and was taken to the ER. An abdom- inal ultrasound showed low arterial flow in her spleen. An AngioCT was performed, revealing a large splenic in- farction. The patient was anticoagulated, first with Low Molecular Weight Heparin and after with Coumadin for one year, keeping the INR target between 2,5 - 3,5.
There were no additional complications. The first TOE showed one mobile thrombus attached to the left disc of the device, and a new examination after two
weeks of therapy revealed its complete resolution.
The patient is under clinical surveillance, was ad- vised to stop contraceptive therapy and a hematologic workup was done after one year of completion Couma-
din therapy has not revealed any thrombotic disorder. Percutaneous closure of ASD is the standard therapy in many cardiac centers. However, complications may occur. Despite rare, late thrombosis can be a potential- ly catastrophic event. It can be related to incomplete endothelialization of the device, and the predictors for this condition are poorly understood. Candidates for device implantation should be carefully screened for potential thrombotic and allergic conditions prior to choosing the ideal therapy. Close follow-up shall be
mandatory in these patients.
Copyright © 2019 Science International Corp.
Key Words
Atrial septal defect • Septal Closure device • Interventional Cardiology
Case Presentation
Percutaneous occlusion of secundum atrial septal defects (ASD) has emerged as the first choice of treat- ment in many cardiac centers, because of less post- operative morbidity and shorter hospital stay when compared to surgery [1, 2]. King and Mills performed the first series of cases in 1976 [3]. However, only af- ter the appearance of the Amplatzer Septal Occluder
* Corresponding Author:
Pablo Tome Teixeirense, MD
Interventional Cardiology
Incorpi - Hospital dos Fornecedores de Cana de Piracicaba Rua Rafael Aloisi, 60, Piracicaba 13405205, Brazil
Tel. +55 19 992046253; E-Mail: pablo.tome@me.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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