'Inverted Tulip': New Deformation of Atrial Septal Defect Closure Devices

We present the case of a 45-year-old woman (62 kg, 160 cm) who suffered an ischemic stroke associated with patent foramen ovale (PFO) with high-risk anatomical features. The defect was percutaneously closed using a LifeTech CeraFlex PFO 30 mm × 25 mm device deployed via a 12 Fr sheath after multiple implantation attempts. Following release, the right atrial disc exhibited a concave deformation, termed the 'inverted tulip,' which prolonged the procedure and resulted in a significant residual shunt. The shunt resolved spontaneously at the 1-month echocardiographic follow-up.