Floating thrombus on an ASD occluder device in a patient with hemophilia A

The case presented is that of a 29-year-old man with a history of hemophilia A who was admitted with recurrent onsets of transient cerebrovascular ischemia; he had undergone a transvenous closure of an atrial septal defects with an occluder device (Cardioseal Starflex) two months ago. Due to a factor-VIII deficiency, no further anticoagulation therapy was initiated. On admission, transesophageal echocardiography revealed a floating thrombus on the left atrial side of the umbrella. The device was explanted via a right minithoracotomy, and the atrial septal defect was closed. The patient had an uneventful recovery.