Iatrogenic erosion of the septum primum resulting in an atrial septal defect with left-to-right shunt: a rare pitfall of patent foramen ovale percutaneous closure

Catheter Cardiovasc Interv. 2014 Sep 1;84(3):494-6. doi: 10.1002/ccd.25333. Epub 2014 Jan 8.

Abstract

Iatrogenic erosion of the septum primum after foramen ovale closure is an anecdotal event. We report the case of a 39-year-old woman admitted to our institution for multifocal cryptogenic cerebral ischemia and a patent foramen ovale (PFO) associated with an aneurysm of the septum primum. The patient underwent percutaneous closure of the PFO with an Amplatzer PFO Occluder device. At the 6-months follow up, the device was in the right position, but a jagged defect of the septum primum and evidence of significant left-to-right shunting was detected. The atrial septal defect was then repaired by a surgical approach. Although this event is not life-threatening, it should be considered as a therapeutic pitfall, resulting in a risk of paradoxical embolism recurrences and long-term hemodynamic impairment. © 2013 Wiley Periodicals, Inc.

Keywords: cerebrovascular disease; complications adult cath/intervention (COMP); congenital heart disease in adults (CHDA); patent foramen ovale (PFO)/atrial septal defect.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Atrial Septum
  • Cardiac Catheterization / methods*
  • Echocardiography, Transesophageal
  • Female
  • Foramen Ovale, Patent / diagnostic imaging
  • Foramen Ovale, Patent / surgery*
  • Heart Septal Defects, Atrial / diagnosis
  • Heart Septal Defects, Atrial / etiology*
  • Humans
  • Iatrogenic Disease*
  • Septal Occluder Device / adverse effects*