Early and Late Cardiac Perforation by Amplatzer Atrial Septal Defect and Patent Foramen Ovale Devices

Cardiac perforation and device erosion are infrequent but potentially lethal complications of percutaneous occluder device insertion. Transthoracic and transesophageal echocardiography (TEE) and gated cardiac computed tomography are useful in detecting this complication. In particular, TEE can detect characteristic features to confirm the diagnosis before rapid surgical correction. Deficient superior-anterior rim and encroachment of the occluder device on the posterior atrial wall are risk factors for device erosion. TEE performed before device insertion with awareness of manufacturer's guidelines for atrial geometry and device sizing may reduce the occurrence of this serious complication.