Late erosion of an Amplatzer septal occluder device 6 years after placement

Abstract

CLINICAL SUMMARY A 46-year-old man underwent transcatheter closure of a PFO at our institution after a stroke-like event. The stretched diameter of the PFO was 9 to 10 mm. A 14-mm Amplatzer septal occluder device (AGA Medical Corporation, Golden Valley, Minn) was placed. Immediately after placement, a trivial degree of left-to-right shunt was seen through the center of the device by intracardiac echocardiography; agitated saline injection revealed a trivial right-to-left shunt. The procedure was uncomplicated, and the patient was dismissed from the hospital the following day. Predismissal transthoracic echocardiogram (TTE) showed good position and stability of the device with no apparent shunt. Ten days later, the patient returned with intermittent palpitations. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. He was given intravenous diltiazem and promptly returned to sinus rhythm. TTE again documentedgoodposition of the occluder devicewith no recurrent atrial shunt or pericardial effusion. He was observed in the hospital overnight and dismissed on a regimen of oral diltiazem for 1 month. He had no recurrence of atrial fibrillation. Six years later, he came to the emergency department with progressive pleuritic chest pain. He had had similar chest pains 1month prior, which were not extensively investigated, but resolved spontaneously. In the emergency department he was hypotensive with mild jugular venous distention. TTE documented moderate pericardial effusion with tamponade. Pericardiocentesis removed 325 mL of bloody fluid. Transesophageal echocardiography did not show any evidence of shunt around the device. The device was again noted to not straddle the aortic root. Transesophageal echocardiographic