Abstract 15989: Gore Cardioform Device Complicated by Delayed Right Atrial Disk Expansion

Abstract

This is a 31-year-old male with a recently discovered secundum atrial septal defect (ASD) with significant left-to-right shunt and associated right ventricular enlargement and dysfunction underwent an uncomplicated percutaneous ASD closure device placement earlier in 2023. Five weeks later, upon repeat transthoracic echocardiogram (TTE), the patient was found to have new onset atrial flutter and what was thought to be a large device-related thrombus abutting the right atrial disc. The patient was admitted to the hospital, started on systemic anticoagulation, and AV nodal blocker therapy. X-rays and a transesophageal echocardiogram (TEE) were performed and showed a Gore Cardioform ASD occluder device that was complicated with significant expansion of the right atrial disk and loosening of fabric likely in the setting of displacement of locking pin (Figure 1A-B). No clear thrombus was visualized. The patient underwent an uncomplicated ASD closure device removal, ASD repair with pericardial patch, right sided Maze, and left atrial appendage ligation in May of 2023 (Figure 1C). We report a case of extreme expansion of the right atrial disk of the Gore Cardioform septal occlusion device. Very few cases of right or left atrial disk expansion have been reported but only in the immediate post-implantation period. This is thought to be secondary to immediate post-operative increase in left atrial pressures. In our patient, intra-procedural TEE and immediate post-procedural TTE the day after showed a well-apposed device across the ASD with no residual shunt. Furthermore, the wedge pressure measured during the procedure was within normal limits. Extreme expansion of the right atrial disk five weeks after the implantation has not been reported. While we know that the pin unlocking caused the expansion of the atrial disk, it is currently unclear as to what initiated this series of events.