Left Atrial Thrombus Associated With Interatrial Septal Occluder 5 Years After Implantation.

Abstract

The patient is a 74-year-old woman with a history of paroxysmal atrial fibrillation, hypertension, and dyslipidemia, who initially presented to an outside hospital in 2009 with a transient ischemic attack. Evaluation identified a patent foramen ovale; a percutaneous closure of the patent foramen ovale was performed using a StarFLEX atrial septal occluder device. In 2010, the patient had a deep venous thrombosis in the setting of several weeks of bed rest following a spinal procedure treated with 3 months of therapeutic anticoagulation with warfarin. Hematologic evaluation did not reveal evidence of hypercoagulable disorder, although the patient was noted to be heterozygous for Factor V Leiden. In 2011, the patient had a routine follow-up echocardiogram that showed preserved systolic function without evidence of intracardiac mass or residual shunt. In October 2014, the patient developed sudden onset chest pain and was found to have a non–ST-segment–elevation myocardial infarction. An echocardiogram showed preserved systolic function with normal regional wall motion; a 2×1.8 cm sessile mass attached to the septal occluder device was identified in the left atrium. Anticoagulation with warfarin was initiated, and the patient was discharged. A transesophageal echocardiogram in January 2015 showed persistence of …