Nicolae Cârstea

Background: Cardiac erosion after transcatheter closure of secundum atrial septal defect (ASD) is a rare (0.1–0.3%) but potentially life-threatening complication. Available evidence remains limited to isolated case reports and small case series. Methods: A case-based review was conducted in accordance with CABARET recommendations. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through January 2026. Adult cases with anatomically confirmed aortic or aorto-atrial erosion after transcatheter closure of a secundum ASD were included. Clinical, anatomical, procedural, imaging, management, and outcome data were synthesized descriptively. An illustrative case with aorto-atrial erosion was included. Results: A total of 40 cases, including the present case, were identified. Median age was 39.5 years, and 27 were female. Chest pain was the most common symptom, reported in 16 cases, whereas six patients were asymptomatic at diagnosis. Median time to erosion was 81 days (range, 0.25–4745 days). A deficient rim was reported in 22 patients, and device oversizing in 17 patients. All erosions involved the aortic wall, most frequently at the atrial roof adjacent to the non-coronary sinus. Aorta-right atrial and aorta-left atrial were the predominant anatomical patterns, reported in 21 and 14 patients, respectively. Surgical intervention was required in 36 cases, which consisted of device explantation with atrial and/or aortic repair. Conclusions: Aortic and aorto-atrial erosion after transcatheter secundum ASD closure is an uncommon but severe complication with heterogeneous clinical presentation and timing. Among published erosion cases, female sex, a deficient retro-aortic rim, device oversizing, and mild aortic root dilation were recurrent characteristics. Careful anatomical assessment, multimodality imaging, and continued follow-up remain essential for early recognition of cardiac erosions.

This report presents the case of a female patient diagnosed with Takayasu arteritis from childhood, with severe, refractory coronary involvement, leading to two acute coronary syndromes and multiple anginous episodes. Consequently, the patient suffered aorto-bicarotid bypass two times, multiple interventional procedures with stent implantation, balloon angioplasty, and up to ten repeated in-stent restenosis that required reinterventions, despite being on maximal immunosuppressive treatment. In recent years, various studies have been reported that aim to best characterize this particular type of vascular damage and to indicate optimal therapeutic options for treatment. The latter should be based on the activity of the underlying disease; however, no reliable markers are available in TA. The management of TA patients with coronary involvement continues to be a challenge and requires both drug and interventional techniques to avoid life-threatening events.