title: Inflammatory pseudothrombus on a patent foramen ovale occluder device.
abstract: Herein, we describe late complications after the transcatheter device closure of a patent foramen ovale in a patient with migraine headaches. The clinical presentation included acute neurologic symptoms and new-onset atrial fibrillation. A mass on the left atrial side of the occluder was surgically removed. Histologic results showed an inflammatory lesion that consisted predominantly of lymphocytes, plasma cells, and macrophages. Despite complete surgical closure and the termination of atrial fibrillation, the patient continued to experience neurologic events. Although transcatheter patent foramen ovale closure is associated with low complication rates, a careful risk-benefit evaluation is warranted in view of the potentially severe complications and the current lack of robust pathophysiologic and clinical trial data to support this therapy in the treatment of migraine headaches.
authors.affiliation: Pueblo Cardiology Associates, Pueblo, Colorado 81004, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: MacKerrow
authors.forename: Andrew
authors.initials: A
authors.lastname: Farb
authors.forename: Roberta
authors.initials: R
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D006348:Cardiac Surgical Procedures; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D054092:Foramen Ovale, Patent / Q000150:complications / Q000628:therapy*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008881:Migraine Disorders / Q000209:etiology; D011474:Prosthesis Design; D012008:Recurrence; D055989:Septal Occluder Device / Q000009:adverse effects*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome