Atrial Thrombus in Severe Pectus Excavatum and Patent Foramen Ovale Closure

Severe pectus excavatum (PE) can distort cardiac anatomy and alter intracardiac flow, yet its contribution to device-associated thrombosis is rarely reported.

A 41-year-old woman with severe PE and a patent foramen ovale closed using an occluder developed recurrent pulmonary and systemic embolic events despite anticoagulation. Imaging revealed biatrial compression, resulting in biatrial injury and device-associated thrombosis. With ongoing left atrial thrombus growth and cerebral embolic events while on anticoagulation therapy, she underwent a single-stage procedure: device explantation, evacuation of thrombus, primary patent foramen ovale closure, and minimally invasive PE repair. Intraoperative transesophageal echocardiography confirmed resolution of cardiac compression and no residual thrombus.

Although thrombosis after occluder placement or in PE has been described, the combination of PE-related compression, intracardiac device, and biatrial thrombus has not. Mechanical cardiac deformation likely contributed to persistent thrombogenesis.

Severe PE-related compression may contribute to persistent device-associated atrial thrombus despite anticoagulation. Combined repair can address the underlying mechanical cause.