Large Left Atrial Thrombus on Amplatzer Septal Occluder Secondary to Medication Nonadherence

Naseem A. Hossain¹, Pramod Theetha Kariyanna¹, Nimrah A. Hossain², Yuvraj Singh Chowdhury¹, Sostanie Takota Enoru¹, Apoorva Jayarangaiah³, Moro O. Salifu¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States- 11203

²Department of Internal Medicine, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York, United States- 11215

³Division of Hematology- Oncology, Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, N.Y., U.S.A 10461

Cite this paper

Naseem A. Hossain, Pramod Theetha Kariyanna, Nimrah A. Hossain, Yuvraj Singh Chowdhury, Sostanie Takota Enoru, Apoorva Jayarangaiah, Moro O. Salifu and Samy I. McFarlane. Large Left Atrial Thrombus on Amplatzer Septal Occluder Secondary to Medication Nonadherence. American Journal of Medical Case Reports. 2020; 8(7):197-201. doi: 10.12691/AJMCR-8-7-10

Abstract

Patent foramen ovale (PFO) is a common clinical entity that is encountered in 20-34% of the general population. In most individuals, this anatomical variation is asymptomatic and goes undetected throughout their lives or is only incidentally discovered on cardiac investigations. In situations when the conduit is large enough and when the right atrial pressure exceeds the left atrial pressure, right to left interatrial flow may occur in these individuals. This creates a channel for translocation of air or thrombi from the venous to the arterial circulation, a phenomenon known as paradoxical embolism. Approximately 25-40% of strokes and transient ischemic attacks in patients less than 60 years of age are classified as cryptogenic and studies have identified a higher prevalence (60%) of PFO in young adults with strokes of unidentifiable etiology. Recent trials have demonstrated utility of PFO closure with mechanical devices for secondary prevention of recurrent strokes in patients aged <60 years of age. The general consensus of post-operative management of PFO closure has been largely drawn from randomized controlled trials and comprises use of aspirin and clopidogrel for 6 months followed by use of aspirin alone for at least 5 years. We present a case of an incidentally discovered left intra-atrial thrombus attached to a PFO closure device in a 36-year-old female with a history of cryptogenic stroke three months after implantation.

Keywords

atrial thrombus, foramen ovale, amplatzer septal occluder

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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