Hemorrhagic pericardial effusion 6 months following atrial septal defect device closure: Has it eroded?

Transcatheter closure of atrial septal defect (ASD) is the preferred modality of treatment. Pericardial effusion occurring late after ASD device closure is extremely rare, and device-related erosion is the most likely possibility. We describe a 41-year-old male who underwent ASD device closure with a 32-mm Amplatzer Septal Occluder device and who developed cardiac tamponade 6 months after the procedure. Extensive investigations did not reveal any evidence of erosion. Given the endemicity of tuberculosis in India, exudative pericardial effusion, a positive tuberculin skin test, and the presence of a few matted mediastinal lymph nodes, the patient was started on antitubercular therapy. There was no reaccumulation of pericardial fluid at subsequent follow-ups. To conclude, not all hemorrhagic pericardial effusions following device closure of ASD are secondary to erosions. After ruling out device erosion, other etiologies for pericardial effusion should be carefully searched for.