Atrial Septal Defect Occluder-Induced Left Atrial Injury: A Paradoxical Source of Embolic Strokes

Transcatheter atrial septal defect closure is a prevalent minimally invasive treatment option but still has cerebrovascular accident (CVA) risk. An unusual thromboembolic CVA cause is device-related mechanical atrial injury. We describe the case of a patient with prior transcatheter atrial septal defect closure who had ongoing CVA despite anticoagulation. Echocardiography showed left atrium wall thrombus from mechanical injury. Operative thrombus removal, device explant, and septal reconstruction was performed with no subsequent CVA. Instead of device thrombosis, here the source was repeated contact by 1 prong with the left atrium wall, causing mechanical injury-induced thrombosis. This rare phenomenon is another source of thromboembolism.