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Thrombus formation 4 years after percutaneous transcatheter closure of an atrial septal defect

A 65-year-old male underwent percutaneous closure of a 15-mm secundum atrial septal defect (ASD) with a 19-mm Amplatzer septal occlusion device (St. Jude Medical Inc., St. Paul, MN) and was placed on aspirin (100 mg/day) for 6 months. A transesophageal echocardiograph obtained at a 4-year follow-up revealed a 2.3 × 0.6-cm mobile mass attached to the left side of the device (Fig. 1). He denied any fevers, chills, pain, or shortness of breath. The patient underwent surgery via a mediansternotomy and bypass was initiated with ascending aortic and bicaval cannulation with mild systemic hypothermia. Following cardioplegic arrest, a right atriotomy was performed. The device appeared to be well enothelialized and there were no right atrial masses. The device was excised with a rim of atrial tissue. The left side of the device contained the mobile thrombotic mass (Fig. 2). The ASD was closed with a pericardial