Late cardiac tamponade after percutaneous closure of a patent foramen ovale

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Patent foramen ovale (PFO) closure is a common procedure for preventing cryptogenic strokes.
• Percutaneous PFO closure devices are generally considered safe, but potential complications require ongoing investigation.
• Long-term outcomes and rare adverse events associated with PFO closure devices need thorough documentation.

Observation:

• A 35-year-old man experienced a transient ischemic attack and subsequently underwent percutaneous PFO closure using a Cardiastar device.
• One year post-procedure, the patient presented with cardiac tamponade secondary to significant hemorrhagic pericardial effusion.
• Transesophageal echocardiography revealed device strut impingement on the aortic root near the transverse pericardial sinus.

Findings:

• Cardiac CT and surgical findings confirmed device strut perforation of the left atrial roof and aortic root.
• The mechanism is hypothesized to be slow erosion of the aortic wall by a device strut, causing pericardial effusion.
• This represents the first reported case of late-onset cardiac tamponade following PFO closure.

Implications:

• This case highlights a rare but serious late complication of PFO closure devices.
• It underscores the critical importance of long-term patient surveillance and echocardiographic monitoring after PFO device implantation.
• Further research into device design and long-term biocompatibility may be warranted to prevent such adverse events.