A 41-year-old female was admitted to hospital with migraineur of patent foramen ovale (PFO). Medical history showed Marfan syndrome treated with Bentall surgery 3 years previously. Computed tomography angiography demonstrated an ascending aortic aneurysm of maximum diameter 59 mm (Panel A).
The decision was made to perform percutaneous PFO closure for the prevention of secondary stroke consistent with current guidelines. A PFO occluder (Huayi, Beijing, China) was inserted (Panel B) and push-pull test showed a stable position (see Supplementary data online, Video S1). The patient developed palpitations and irregular heart rate on the second day. Transthoracic echocardiography and X-ray showed detachment of the occluder into the left ventricle (Panels C and D). Tracheal intubation was performed under general anaesthesia and a bilateral femoral vein approach established. The PFO occluder was removed (Panels E–G; see Supplementary data online, Videos S2–S4) and one atrial septal occluder (Huayi, Beijing, China) was re-inserted (Panel H). Push-pull test and transoesophageal ultrasound showed a stable position (Panel I; see Supplementary data online, Videos S5 and S6). The patient made a successful recovery.
PFO occluder detachment is a rare but lethal event and requires prompt intervention. The current PFO was complicated with Marfan syndrome which may lead to thinning of the atrial septum, increasing the instability of the occluder which may detach. To the best of our knowledge, this is the first report of plugging–shedding–replugging for PFO with Marfan syndrome.
Z.C. contributed to conceptualization: lead; data curation: lead; formal analysis: lead; validation: lead; visualization: lead; writing—original draft: lead; writing—review & editing: lead. J.P. contributed to conceptualization: equal; validation: equal; visualization: equal; writing—review & editing: equal. W.W. contributed to conceptualization: equal; data curation: equal; resources: equal; validation: equal; visualization: equal; writing—review & editing: equal.
Supplementary data is available at European Heart Journal online.
The authors have submitted their declaration which can be founded in the article supplementary Material online.
Supplementary Material
Contributor Information
Zhang Cheng, Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Junzhou Pu, Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
Wenhui Wu, Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
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