Removal of a left atrial thrombus adherent to a patent foramen ovale occluder

A 62-year-old man presented with bilateral thromboembolic occlusion of the lower leg arteries 8 months after closure of a patent foramen ovale with an Amplatzer patent-foramen-ovale occluder (AGA Medical Corporation, Plymouth, MN). Then he developed an acute myocardial ischemia. A left heart catheter revealed thromboembolic occlusion of the right coronary artery, and echocardiography demonstrated a thrombus attached to the device within the left atrium. Cerebral computer tomography showed a new ischemic lesion. In an emergency procedure, the device and the left atrial thrombus were removed, the septal defect was closed, and a coronary artery bypass grafting was performed. The patient was discharged from the hospital in stable condition.