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European Journal of Echocardiography 2007 8(4):298-302; doi:10.1016/j.euje.2006.03.015
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Copyright © 2006, The European Society of Cardiology

Inflammatory, abscess-forming foreign body reaction mimics a thrombus formation on an atrial septal defect closure device: A commented case report

Dimitar Divcheva,*, Edith Katharina Podewskia, Michael Mengelb, Gerd Peter Meyera, Helmut Drexlera and Arnd Schaefera

aHannover Medical School, Department of Cardiology and Angiology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
bDepartment of Pathology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany

Received 27 January 2006; received in revised form 21 March 2006; accepted after revision 30 March 2006.

* Corresponding author. Tel.: +49 511 532 2532; fax: +49 511 532 3357. divchev.dimitar{at}mh-hannover.de


  Abstract

We are presenting a case of floating left and right atrial formations on an atrial septal defect occluder system (23mm StarFLEX®-Occluder) initially supposed to be thrombotic appositions in a 57-year-old man. The closure was performed on the background of left hemispheric stroke and atrial septal aneurysm (ASA) with patent foramen ovale (PFO). The suspect structures were detected in the 6-month follow-up by transesophageal echocardiography (TEE). The patient underwent a successful surgical explantation of the closure device and closure of the patent foramen ovale (PFO) using a pericardial patch. The pathological evaluation of the biatrial device associated appositions revealed hytrophic heart muscle tissue with perifocal scarring and purulent abscess-forming, granulating and foam-cell including inflammatory foreign body reaction instead of the expected thrombus formation.

Keywords: TEE, transesophageal echocardiography; ASD, atrial septal defect; PFO, patent foramen ovale; ASA, atrial septal aneurysm; INR, international normalized ratio


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