When time flies by: very long-term complication of percutaneous occlusion of a large atrial septal defect—a case report

Background: Very late complications of percutaneous closure of atrial septal defects (ASD) are rare and poorly described in literature. Case summary: A 53-year-old woman presented with acute-onset diplopia and aphasia. She was diagnosed with ischaemic stroke and underwent thrombolysis. Brain magnetic resonance imaging showed bilateral thalamic infarcts. Workup revealed a residual shunt through a previously implanted Amplatzer occluder placed 21 years earlier for a large, fenestrated ASD. Transoesophageal echocardiography demonstrated device-associated thrombus and significant right-to-left shunting on Valsalva. Percutaneous reclosure was unsuccessful due to a serpiginous intracardiac tract. Surgical removal of the device, septal reconstruction, and tricuspid valvuloplasty were performed via right minithoracotomy. Post-operative recovery was uneventful, and the patient remained asymptomatic at 6-month follow-up. Discussion: Very late device-related complications, even decades after percutaneous ASD closure, may occur. Lifelong follow-up in patients with complex ASD is needed. Surgical closure may be considered in anatomically challenging cases to reduce long-term risk.