Management of atrial thrombus formation following surgical closure of an atrial septal defect

Abstract

Acute thrombus formation on pericardial patches used to close atrial septal defects (ASDs) is uncommon. We present two patients with thrombus formation on native pericardial patches following ASD closure and discuss the management of this complication.

Thrombus formation in the right atrium after surgical closure of atrial septal defect

“…[59] Thrombus formation may occur on occluder devices, patches, or primary suture regions. [256] In our case, the formation of two thrombi originated from the site of atrial trauma by suction and on the suture in the pericardial patch area. The suture line serves as the nidus for thrombus formation and facilitates it.…”

“…[4] Thrombus formation may be seen in the early or late postoperative period. [25] It usually takes the form of an acute thromboembolic complication after both device and surgical patch-based repairs of ASD,[67] but as seen in our cases, it can be diagnosed late. [8] Clinical representation in patients may present across a broad spectrum ranging from asymptomatic to atypical chest pain or exertional dyspnea.…”

“…[1] Various complications such as atrial arrhythmias and development of thrombus have been reported after surgical closure. [23] Herein, we present a case of right atrial thrombi formed at different localizations in the right atrium in a patient who was asymptomatic and diagnosed late.…”

Left atrial thrombi following tranexamic acid in a bleeding trauma patient-A word of caution

“…Intra‐cardiac clot formation following cardiac procedures are rare but have been described following atrial septal defect repairs with autologous pericardium in the absence of clotting deficiencies . The administration of IV heparin, in the absence of bleeding, would appear to be the most effective method to dissolve the clot and minimize the risk for thromboembolic events.…”

Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models

“…These valves are made from chemically processed animal-derived material, for example, cross-linked bovine pericardium or synthetic polytetrafluoroethylene material ( 7 , 13 ). Immune-related failure can lead to immobile valve cusps because of chronic inflammation from foreign materials, causing issues like thromboembolic complications or infectious endocarditis ( 14 – 16 ). Posttreatment regurgitation rates vary substantially because of the numerous variables of design, morphology, surgery, and immune response ( 17 ).…”