Transcathether occlusion of interatrial communications: postprocedural transoesophageal echocardiography allows timely detection and treatment of intracardiac thrombus formation.
OBJECTIVE
Thrombus formation leading to ischaemic stroke is a major concern after transcathether occlusion of interatrial communications. The aim of our study was to verify if postprocedural transoesophageal echocardiography (TEE) might improve timely detection and management of thrombus formation.


RESULTS
We studied 65 patients with patent foramen ovale or atrial septal defect who received an atrial septal closure device. Transoesophageal echocardiography was used to guide the procedure, and was repeated <1 h after the end of the procedure, at 30 day and 6 month follow-up visits. Transoesophageal echocardiography <1 h after procedure revealed a left-sided thrombus attached to the device in three patients. All cases were successfully treated by thrombolytic therapy with full-dose tenecteplase (0.53 mg/kg in 5-10 s) with disappearance of thrombus in 15-60 min. No cerebrovascular event was recorded during a follow-up of 311 +/- 235 days.


CONCLUSIONS
Thrombus formation on interatrial closure devices can occur soon after device implantation and can be timely detected by postprocedural TEE.
Pelliccia
Francesco
F
Interventional Cardiology Unit, San Filippo Neri Hospital, Rome. f.pelliccia@mclink.it
Cianfrocca
Cinzia
C
Pasceri
Vincenzo
V
Granatelli
Antonino
A
Speciale
Giulio
G
Roncella
Adriana
A
Turturo
Maurizio
M
Richichi
Giuseppe
G
Pristipino
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control; D000077785:Tenecteplase; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D018084:Ultrasonography, Interventional; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase