Biatrial Thrombi on a Gore Septal Occluder Despite Early Epithelialization

ASD and PFO device-related thrombus is an uncommon phenomenon that can be seen both early- and late-post-closure. Typical risk factors include atrial fibrillation, hypercoagulable diseases/states, and lack of device endothelialization. We present an interesting case of a 15-year-old female who underwent PFO device closure after a renal infarction and was found to have biatrial device thrombus 3-month post-closure. She initially was managed with anticoagulation and antiplatelet therapy with intermittent systemic tPA but subsequently developed a new left atrial thrombus after complete resolution. Her device was surgically removed and found to be fully endothelialized. Her case highlights the lack of current guidelines for ASD/PFO device-related thrombus.