Bi-atrial thrombus after occlusion of atrial septal defect with acute
cerebral infarction and pulmonary embolism
Abstract
A 49-year-old male presented to hospital with symptoms of acute cerebral
infarction and pulmonary embolism who underwent transcatheter closure of
atrial septal defect a year ago. Transthoracic echocardiography showed a
13×9 mm hypoechoic mass attached to the left-atrial side of the device,
which was suspected to be neoplasm or thrombus. The patient was
indicated for surgery after multidisciplinary discussion due to
ineffective medical therapy and typical stroke and pulmonary embolism
symptoms. Three-dimensional transesophageal echocardiography (3D-TEE)
revealed left-atrial vegetation (21×16 mm) and right-atrial vegetation
(8×6 mm) attached to the device, which were confirmed as thrombus by
surgical separation and laboratory examination. This case highlights the
importance of 3D-TEE and a multidisciplinary team in the diagnosis and
therapy of device-related thrombus.