Page 41 - Journal of Structural Heart Disease Volume 5, Issue 6

265 Case Report
Figure 3. TOE showing mobile thrombus attached to the occluder’s left atrial disk.
We present a case of a 19-year-old female who presented with a very late systemic thrombotic com- plication after percutaneous treatment of a large size ASD.
The patient had been treated six years before, with implantation of a 33mm Occlutech® Figulla® ASD oc- cluder (Figure 1). The implant was guided by the 2-D transoesophageal TOE. There were no complications during the procedure or in the postoperative peri- od. The patient was advised to take DAPT (ASA plus Clopidogrel) for 6 months after the procedure, but she decided personally not to take any medication, and even so, she had not any immediate and late thromboembolic complications.
Transthoracic echocardiograms (TTE) performed at one and six months, as well as a transoesophageal echocardiogram (TOE) at twelve months after the procedure showed a well-implanted device, no resid- ual shunts and no signs of thrombus.
Six years after the procedure, the patient was tak- ing only contraceptive therapy and never smoked.
The initial symptom was acute abdominal pain. An abdominal ultrasound showed low arterial spleen flow. An AngioCT was performed, revealing a large splenic apical infarction, and multiple small ischemic areas in the spleen (Figure 2). Anticoagulation was initiated, first with Low Molecular Weight Heparin (LMWH) and after with Coumadin for one year, keep- ing the INR target between 2,5 to 3,5.
There were no additional complications. The first TOE showed one mobile thrombus attached to the left disc of the device (Figure 3 & Video 1), and a new examination after two weeks of therapy revealed the complete resolution of the thrombus.
After one year of anticoagulation, the patient had a complete hematologic workup, including Factor V Leiden, Prothrombin G20210A mutation, Protein C and S, Antithrombin III, Antiphospholipid antibodies (Anticardiolipin and Lupus anticoagulant) and Homo- cysteine, that have not shown any disorder. After that, she was prescribed ASA and Clopidogrel indefinitely, although the patient refused to take the medications.
Teixeirense P. T. et al.
Thrombosis of an Occluder and Splenic Infarction