A 62-Year-Old Woman with Recurrent Hemorrhagic Pericardial Effusion

A 62-year-old woman presented with recurrent hemorrhagic pericardial effusion and symptoms of early tamponade. Her history included transcatheter closure of a fenestrated atrial septal defect (ASD) with a 30-mm Amplatzer device placed 14 years prior, and substantial weight loss following sleeve gastrectomy. Imaging revealed a circumferential pericardial effusion adjacent to the device, which abutted the aortic root and atrial wall. Although transesophageal echocardiography and CT angiography showed no active bleeding or aortoatrial fistula, intraoperative inspection revealed erosion of the device into epicardial fat. The device was surgically removed and the atrial septum repaired with autologous pericardial patch. Pathologic evaluation confirmed erosion. The case illustrates a rare but serious late complication of device erosion, possibly facilitated by post-weight-loss atrial remodeling. Follow-up showed complete resolution of symptoms and effusion, with long-term echocardiography confirming recovery.

A 62-year-old woman presented with recurrent hemorrhagic pericardial effusion and symptoms of early tamponade. Her history included transcatheter closure of a fenestrated atrial septal defect (ASD) with a 30-mm Amplatzer device placed 14 years prior, and substantial weight loss following sleeve gastrectomy. Imaging revealed a circumferential pericardial effusion adjacent to the device, which abutted the aortic root and atrial wall. Although transesophageal echocardiography and CT angiography showed no active bleeding or aortoatrial fistula, intraoperative inspection revealed erosion of the device into epicardial fat. The device was surgically removed and the atrial septum repaired with autologous pericardial patch. Pathologic evaluation confirmed erosion. The case illustrates a rare but serious late complication of device erosion, possibly facilitated by post-weight-loss atrial remodeling. Follow-up showed complete resolution of symptoms and effusion, with long-term echocardiography confirming recovery.