Aortic Wall Erosion after Percutaneous Closure of Atrial Septal Defect

A 26-year-old woman presented with acute hemolysis 1 month after percutaneous closure of an atrial septal defect. Three-dimensional transesophageal echocardiography was used to establish the diagnosis of a fistula from the aorta, toward the device and both atria. The patient required urgent surgical correction. Transcatheter closure of atrial septal defects has proven to be a highly successful alternative to surgery in the appropriate patient. Cardiac perforation and device erosion of the aortic wall are infrequent but potentially lethal complications of percutaneous occluder device insertion. Supportive features of device erosion include a wrong preimplantation assessment of the rims, the device extends across the atrial septum, and the device encroaches on the surrounding structures. In this case, the presumed mechanism of aortic fistula was aortic erosion by the left atrial disk of the occluder device.