When Time Flies By: Very Long Term Complication of Percutaneous Occlusion of a Large Atrial Septal Defect, a Case Report

Background Very late complications of percutaneous closure of atrial septal defects (ASD) are rare and poorly described in literature. Case Summary A 53-year-old woman presented with acute-onset diplopia and aphasia. She was diagnosed with ischemic stroke and underwent thrombolysis. Brain MRI showed bilateral thalamic infarcts. Workup revealed a residual shunt through a previously implanted Amplatzer occluder placed 21 years earlier for a large, fenestrated ASD. Transesophageal echocardiography demonstrated device-associated thrombus and significant right-to-left shunting on Valsalva. Percutaneous reclosure was unsuccessful due to a serpiginous intracardiac tract. Surgical removal of the device, septal reconstruction, and tricuspid valvuloplasty were performed via right minithoracotomy. Postoperative recovery was uneventful, and the patient remained asymptomatic at six-month follow-up. Conclusion Very late device-related complications, even decades after percutaneous ASD closure may occur. Life-long follow-up in patients with complex ASD is needed. Surgical closure may be considered in anatomically challenging cases to reduce long-term risk.