Inflammatory pseudothrombus on a patent foramen ovale occluder device
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Updated: May 26, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Stephen MacKerrow1, Andrew Farb, Roberta Sullivan
1Pueblo Cardiology Associates, Pueblo, Colorado 81004, USA.
Abstract:
Herein, we describe late complications after the transcatheter device closure of a patent foramen ovale in a patient with migraine headaches. The clinical presentation included acute neurologic symptoms and new-onset atrial fibrillation. A mass on the left atrial side of the occluder was surgically removed. Histologic results showed an inflammatory lesion that consisted predominantly of lymphocytes, plasma cells, and macrophages. Despite complete surgical closure and the termination of atrial fibrillation, the patient continued to experience neurologic events. Although transcatheter patent foramen ovale closure is associated with low complication rates, a careful risk-benefit evaluation is warranted in view of the potentially severe complications and the current lack of robust pathophysiologic and clinical trial data to support this therapy in the treatment of migraine headaches.
Insights
Transcatheter closure of patent foramen ovale for migraines led to late complications, including neurologic events and atrial fibrillation. Careful risk-benefit assessment is crucial due to potential severe outcomes.
Area of Science:
- Cardiology
- Neurology
Background:
- Patent foramen ovale (PFO) closure is sometimes considered for migraine treatment.
- Transcatheter device closure is a common PFO closure method.
Observation:
- A patient undergoing PFO closure for migraines developed late complications.
- These included acute neurologic symptoms and new-onset atrial fibrillation.
- A surgically removed mass revealed an inflammatory lesion.
Findings:
- Histology showed an inflammatory lesion with lymphocytes, plasma cells, and macrophages.
- Neurologic events persisted despite successful PFO closure and atrial fibrillation termination.
Implications:
- Transcatheter PFO closure, while generally safe, carries risks of severe late complications.
- Further research is needed to establish the efficacy and safety of PFO closure for migraines.
