Late Recurrent Left Atrial Mass in Patient With Patent Foramen Ovale Occluder Device

Patent foramen ovale (PFO) closure is a widely used procedure to manage recurrent cryptogenic stroke, with most complications occurring in the early postimplantation period. Very late device-related thrombosis, especially more than a decade after placement, is a rare presentation with unique diagnostic and management challenges. We present a case of thromboembolic stroke caused by a left atrial mass of unknown origin attached to a PFO occlusion device placed 15 years prior. Pathology suggested an infectious origin, but an extensive infection workup was negative. The patient experienced early recurrence after surgical excision, which required reoperation and device extraction. Device-related thrombus formation after PFO closure is a rare but recognized complication, which typically occurs within the first few years after implantation. Reports of thrombus formation more than a decade after device implantation, with immediate recurrence after surgical excision, are exceptionally uncommon. This case is interesting because of its unique presentation of a very late, recurrent thrombus in a patient without typical risk factors, highlighting the need for long-term vigilance in PFO occluder patients.