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Case Reports
. 2021 Aug 4;5(8):ytab313.
doi: 10.1093/ehjcr/ytab313. eCollection 2021 Aug.

Recurrent stroke secondary to late patent foramen ovale-closure device thrombus: a case report

Lennox Jerzyna  1 , Abhisheik Prashar  2   3 , George Youssef  2   3 , Mark Sader  2   3
Affiliations
Case Reports

Recurrent stroke secondary to late patent foramen ovale-closure device thrombus: a case report

Lennox Jerzyna et al. Eur Heart J Case Rep. .

Abstract

Background: Percutaneous patent foramen ovale (PFO) closure has been well established in the secondary prevention of cryptogenic stroke with overall low rates of procedural complications. One such complication is PFO closure device thrombus formation which is now rarely reported with newer generation devices.

Case summary: We present the unusual case of a 59-year-old woman with myelofibrosis who developed late-onset recurrent embolic strokes related to Amplatzer PFO closure device thrombus whilst therapeutically anticoagulated on Warfarin. Surgical management was deemed too high risk and our patient was conservatively managed with enoxaparin. Serial transthoracic echocardiography demonstrated a reduction in thrombus size and the patient had no further neurological events.

Discussion: Overall, the risk of serious complications following percutaneous PFO closure, such as device-associated thrombus, remains low. The risk of thrombus formation in patients with hypercoagulable states is not well characterized. Despite good evidence for the efficacy in preventing recurrent cryptogenic stroke, the role of PFO closure in addition to anticoagulation is unclear. Given this uncertain benefit of PFO closure in anticoagulated patients and the unclear risk profile, patient selection, and thorough pre-procedural evaluation are vital when assessing the appropriateness of percutaneous PFO closure.

Keywords: Case report; Myelofibrosis; PFO closure device; Patent foramen ovale; Stroke; Thrombus.

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Figures

Figure 1
Figure 1
(A) Zoomed apical two-chamber view demonstrating 1.0 cm × 1.8 cm left atrial thrombus. (B) Apical two-chamber view demonstrating left atrial thrombus. (C) Apical three-chamber view demonstrating large left atrial thrombus adherent to patent foramen ovale-closure device. (D) Apical four-chamber view demonstrating mobile left atrial thrombus adjacent to patent foramen ovale-closure device.
Figure 2
Figure 2
Apical four-chamber view demonstrating significant separation of the left atrial disc from the inter-atrial septum which represents a potential nucleation point for the development of thrombus. Mobile left atrial thrombus attached to the patent foramen ovale-closure device is also demonstrated.
Figure 3
Figure 3
(A) Post-anticoagulation apical four-chamber view showing reduced thrombus (red arrow) size 6 days following initiation of anticoagulation. (B) Post-anticoagulation zoomed apical four-chamber view showing residual left atrial thrombus adjacent to patent foramen ovale-closure device (red arrow).
None
See this image and copyright information in PMC

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