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