LATE PERFORATION OF RIGHT ATRIUM AND AORTIC ROOT AFTER PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE

Percutaneous transcatheter closure of ASD or PFO has been performed since 1976 as an alternative to conventional surgical repair with various types of mechanical occluder devices.3 The Amplatzer septal occluder is a model of such devices and was approved by the Food and Drug Administration in December 2001. A good rate of successful closure has been reported. Nevertheless, cases of late complications necessitating emergency surgical procedures have been described.4 Our patient had important anatomic injuries. His hemodynamically stabile condition at the time of surgical repair was a fortunate situation. Classic open heart surgery remains the standard of care for ASD repair with excellent outcomes since 1954, providing low operative mortality and morbidity. Percutaneous closure is growing rapidly, principally because of the patient’s, family’s, and pediatric cardiologist’s desire for a less invasive procedure. Considering the increase in the number of procedures, a long-term follow-up is necessary to evaluate the safety of mechanical occluders at long term. Our case report described a complication that occurred 13 months after the percutaneous procedure. The literature includes other authors reporting delayed heart perforation by the occluder device5; hence this patient’s need for long-term echocardiographic follow-up to made an early diagnosis of device failure and prevent emergency surgical intervention. Finally, we conclude that patients should be informed of the actual early and long-term results of surgical repair and percutaneous approach to allow an informed decision.