Acute Pericardial Tamponade as a Remote Complication of a CardioSEAL Atrial Septal Defect Closure Device

Abstract

CLOSURE OF A secundum atrial septal defect (ASD) or a patent foramen ovale (PFO) using a percutaneously deployed transcatheter occlusion device has emerged as a safe, less invasive, and widely accepted alterative to open surgical repair of these common congenital heart defects in adults 1 Chessa M. Carminati M. Butera G. et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 2002; 39: 1061-1065 Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar , 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar and children. 3 Butera G. De Rosa G. Chessa M. et al. Transcatheter closure of atrial septal defect in young children Results and follow-up. J Am Coll Cardiol. 2003; 42: 241-245 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar Despite the demonstrated utility of transcatheter occlusion devices in the vast majority of patients, as many as 8% of patients undergoing percutaneous closure of an ASD or PFO require surgical intervention for device failure or the management of complications. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar A wide variety of acute and chronic complications of transcatheter devices has been previously described in the literature, including the presence of a hemodynamically significant residual shunt after device deployment 5 Bohm J. Bittigau K. Kohler F. et al. Surgical removal of atrial septal defect occlusion system-devices. Eur J Cardiothorac Surg. 1997; 12: 869-872 Crossref PubMed Scopus (43) Google Scholar ; recurrent cerebral embolism 6 Z’Brun A. Dai-Do D. Meier B. et al. Recurrent systemic embolism after transcatheter closure of a patent foramen ovale. Eur J Cardiothorac Surg. 1997; 12: 813-814 Crossref PubMed Google Scholar ; device deformation, malposition or embolization 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; thrombus formation 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar ; entanglement of the device in a Chiari network 8 Cooke J.C. Gelman J.S. Harper R.W. Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device. J Am Soc Echocardiogr. 1999; 12: 601-603 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ; endocarditis 9 Goldstein J.A. Beardslee M.A. Xu H. et al. Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale. Catheter Cardiovasc Interv. 2002; 55: 217-220 Crossref PubMed Scopus (34) Google Scholar ; device-induced mitral regurgitation 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; and cardiac perforation. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar In this report, the authors describe the occurrence of acute pericardial tamponade 5 years after implantation of a CardioSEAL septal occluder (Nitinol Medical Technology, Boston, MA) as a result of erosion of a device wire support through the dome of the left atrium (LA) and briefly discuss the perioperative management of the patient.