Journal of Clinical Case Reports

Allergic Reaction to Percutaneously Placed Amplatzer Device for Symptomatic Patent Foramen Ovale

Abstract

Hamza Zaheer Ansari and Saihari Sadanandan

Transcatheter placement of patent foramen ovale occluders is an alternative to open heart surgery for repair of PFO’s. We present a case of a 33 years old male with a previously unknown nickel allergy who developed a severe allergic response after placement of a nitinol based cribriform amplatzer device, for closure of symptomatic PFO. Our patient presented with neurological symptoms consisting of visual field defects and right sided weakness. MRI showed a left hemispheric parieto-occipital. An echocardiogram showed a large PFO. He was discharged eventually with a plan for long term anticoagulation. However he presented again with similar symptoms in a few days. Due to recurrence of symptoms his neurologist recommended PFO closure. This was successfully closed percutaneously using a 25 mm amplatzer cribriform device and no residual shunt was seen. The patient returned two days later with shortness of breath, chest pain and a pruritic rash. All further laboratory testing was negative. Suspecting nickel allergy, testing was performed with a 25 mm cribriform device taped to the patients left arm. He was then referred to cardiothoracic surgery for explantation of the amplatzer device which resulted in resolution of his symptoms. Nitinol is the material that constitutes amplatzer occluders. Though considered safe for PFO closure, there are reports of allergic responses to it. Here we have an early onset case of an allergic response to the device with a novel way to test for allergies using the device itself, with an emphasis on questioning patients regarding allergies and testing them as well.