Figure 2.

Thrombus on the left atrial side of a percutaneous PFO closure device The patient had a Stroke in 2000 at the age of 54 years; PFO closure was performed using a CardioSEAL device in 2003. In 2008, he had a transient ischemic attack; echocardiography showed thrombus on the device. The thrombus failed to dissolve in 6 months of intensive anticoagulation, so open heart surgery was performed in 2009 to remove the thrombus and the device, with surgical closure of the PFO. The upper panel shows the open left atrium; lower left image is the echocardiographic image of the thrombus (white arrow). Lower right image is the surgically removed device. (Courtesy of Dr. Bob Kiaii and Dr. Bryan Dias, University Hospital, London, Canada.)