GORE® CARDIOFORM ASD occluder thrombus in a patient of rheumatoid arthritis occurred three days after deployment

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Catheter-based closure is a common treatment for secundum atrial septal defects (ASD).
• Patients with rheumatoid arthritis may have specific considerations during device implantation.
• The GORE® CARDIOFORM ASD occluder is a device used for transcatheter closure.

Observation:

• A mobile echogenic mass, suggestive of thrombus, was detected on the right side of the ASD occluder three days post-procedure.
• The patient had received aspirin and intravenous heparin prior to and following the device deployment.

Findings:

• Continuous intravenous heparin and the addition of clopidogrel led to the resolution of the mobile echogenic mass within 24 hours.
• This case highlights the potential for early device thrombosis after ASD closure, even with standard anticoagulation.

Implications:

• Device thrombosis, although infrequent, is a significant complication of ASD device closure, carrying risks of embolism.
• Consideration of dual antiplatelet therapy or enhanced anticoagulation is warranted in patients with elevated thrombosis risk.
• This underscores the importance of vigilant post-procedural monitoring and tailored antithrombotic strategies.