Abstract
Percutaneous occlusion of atrial septal defect (ASD) has emerged as the first approach of treatment in many cardiac centers, because of lower post-procedure morbidity and shorter hospital stay when compared to open-heart surgery. However, there is scarce information on very late complications.
We present a case of a 19-year-old girl who had a very late systemic thrombotic complication. The patient was treated six years before, with the implant of an Occlutech® Figulla® (Helsinborg, Sweden) 33mm device for closing a secundum ASD. The implant was guided 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 abdominal ultrasound showed low arterial flow in her spleen. An AngioCT was performed, revealing a large splenic infarction. 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 advised to stop contraceptive therapy and a hematologic workup was done after one year of completion Coumadin 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 potentially 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.
Case Reports
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:263-267
DOI: 10.12945/j.jshd.2020.005.19
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
Abstract
Percutaneous occlusion of atrial septal defect (ASD) has emerged as the first approach of treatment in many cardiac centers, because of lower post-procedure morbidity and shorter hospital stay when compared to open-heart surgery. However, there is scarce information on very late complications.
We present a case of a 19-year-old girl who had a very late systemic thrombotic complication. The patient was treated six years before, with the implant of an Occlutech® Figulla® (Helsinborg, Sweden) 33mm device for closing a secundum ASD. The implant was guided 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 abdominal ultrasound showed low arterial flow in her spleen. An AngioCT was performed, revealing a large splenic infarction. 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 advised to stop contraceptive therapy and a hematologic workup was done after one year of completion Coumadin 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 potentially 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.
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Cite this article as: Teixeirense PT, de Toledo JFB, Gubolino LA, Bragalha AA, Pereira CA. Very Late Thrombosis of an Atrial Septal Defect Occluder Device Causing a Massive Splenic Infarction. Structural Heart Disease 2019;5(6):263-267. DOI: 10.12945/j.jshd.2020.005.19
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