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European Journal of Echocardiography Advance Access published online on November 25, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen306
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Transcathether occlusion of interatrial communications: postprocedural transoesophageal echocardiography allows timely detection and treatment of intracardiac thrombus formation

Francesco Pelliccia*, Cinzia Cianfrocca, Vincenzo Pasceri, Antonino Granatelli, Giulio Speciale, Adriana Roncella, Maurizio Turturo, Giuseppe Richichi and Christian Pristipino

Interventional Cardiology Unit, San Filippo Neri Hospital, Rome

Received 23 July 2008; accepted after revision 4 November 2008.

* Corresponding author: Via Tommaso Inghirami 79, 00179 Rome, Italy. Tel: +39 06 33062504; fax: +39 06 3306 2516. E-mail address: f.pelliccia{at}mclink.it


  Abstract

Aims: 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.

Methods and 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.

Conclusion: Thrombus formation on interatrial closure devices can occur soon after device implantation and can be timely detected by postprocedural TEE.

Keywords: Atrial septal communication; Thrombus; Thrombolysis; Transcatheter occlusion; Transoesophageal echocardiography


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