Risk of thrombus formation on devices used to close transcatheter atrial septal defect and patent foramen ovale

Case report: Early thrombosis in left atrial during transcatheter closure of ASD in a child with favorable outcome after use of GPIIb/IIIa receptor antagonist and heparin

Background

Acute thrombus in atrial septal defect occluders is a rare complication that requires aggressive, effective, and safe management. Tirofiban, a platelet glycoprotein IIb/IIIa receptor antagonist, is widely used for the management of thromboembolic diseases, such as coronary heart disease and stroke. To date, there is no report using the GPIIb/IIIa receptor antagonist tirofiban for the management of ASD closure-related thrombosis in children.

Case presentation

Herein, we reported a case of a 5-year-old girl with ASD who presented with acute thrombus on the left disc of the occluder device immediately after transcatheter closure of ASD. The thrombus was successfully dissolved 24 h after a combined infusion of heparin and tirofiban, followed by 1 months of aspirin and clopidogrel and 5 months of aspirin alone. No thromboembolism or hemorrhage events occurred during follow-up for more than 2 years.

Conclusion

The continuous infusion of GPIIb/IIIa receptor antagonist tirofiban combined with heparin may have beneficial effects for the management of thrombosis during ASD closure procedure.

Embolic stroke due to a left atrial thrombus two years after placement of an atrial septal defect closure device

A 29-year-old woman who had undergone closure of a secundum-type atrial septal defect using the Amplatzer device 2 years previously developed acute and progressive altered mentation. Initial clinical and imaging data confirmed the diagnosis of multiple cerebral, cerebellar and brain stem emboli, and infarcts. She was treated urgently with an intra-arterial thrombolytic agent with only minimal improvement. Transesophageal echocardiography revealed a large thrombus attached to the left atrial disc of the atrial septal defect occluder, which was the source of the emboli. In conclusion, this is the first reported case, to our knowledge, of disseminated cerebral emboli and infarctions as a late complication of transcatheter closure of a secundum-type atrial septal defect.