Key result
Suspected StarFLEX occluder thrombus proves to be an inflammatory foreign-body reaction on pathology.
Why the study?
Inflammatory foreign body reactions mimicking thrombus formation on atrial septal defect closure devices can complicate diagnosis and management.
Case Report (n=1)
Foreign body reactions to atrial septal defect closure devices can mimic thrombus formation on echocardiography and may require surgical explantation.
Apparent device thrombi may represent foreign body reactions warranting explantation; this case leaves open their prevalence across occluder types.
We are presenting a case of floating left and right atrial formations on an atrial septal defect occluder system (23mm StarFLEX)-Occluder) initially supposed to be thrombotic appositions in a 57-year-old man. The closure was performed on the background of left hemispheric stroke and atrial septal aneurysm (ASA) with patent foramen ovale (PFO). The suspect structures were detected in the 6-month follow-up by transesophageal echocardiography (TEE). The patient underwent a successful surgical explantation of the closure device and closure of the patent foramen ovale (PFO) using a pericardial patch. The pathological evaluation of the biatrial device associated appositions revealed hytrophic heart muscle tissue with perifocal scarring and purulent abscess-forming, granulating and foam-cell including inflammatory foreign body reaction instead of the expected thrombus formation.
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Divchev et al. (2006) conducted a case report in Foreign body reaction on atrial septal defect closure device (n=1). 23mm StarFLEX Occluder was evaluated on Pathological evaluation of device-associated appositions. Pathological evaluation of suspected thrombotic appositions on a 23mm StarFLEX occluder revealed an inflammatory, abscess-forming foreign body reaction rather than thrombus.
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