What Is the Cardiac Erosion Risk After ASD/PFO Closure?

Cardiac erosion is a very rare but serious complication where the edges of an ASD or PFO closure device rub against and wear through the tissue of the heart wall or nearby blood vessels. While reading about it can be frightening, it is important to know that it is extremely rare, and most closure procedures happen safely without this issue ^[1][2]. Your care team is trained to carefully evaluate your heart’s anatomy before the procedure to minimize risks, and they will closely monitor you via echocardiograms in the days and months following your implantation ^[3][4].

What exactly is cardiac erosion?

When a doctor places a closure device to seal an Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO), the device sits against the wall separating the heart’s upper chambers. In very rare cases, the natural movement of the beating heart causes the edges of the device to repeatedly rub against the heart tissue ^[5][6]. Over time, this friction can wear away the tissue—a process called erosion. If the device wears through the wall, it can cause bleeding around the heart (a condition known clinically as hemopericardium or cardiac tamponade). This is a medical emergency that requires surgery to remove the device and repair the affected heart wall ^[6][7].

How rare is it?

Cardiac erosion is incredibly rare. The exact risk depends on the specific device used, but overall, it happens in a tiny fraction of patients—estimated at 1 to 3 out of every 1,000 procedures (0.1% to 0.3%) ^[1][2].

Because ASDs are typically larger than PFOs, they require larger closure devices. As a result, the vast majority of cardiac erosion cases have been associated with ASD closure devices rather than PFO devices ^[6][3]. While the risk with PFO closures is not zero, some types of PFO devices have no published reports of erosion at all ^[8][9].

Who is at a higher risk?

Research shows that cardiac erosion doesn’t happen randomly. It is most often linked to specific anatomical factors that your doctor will look for before deciding if a device is safe for you ^[10][6]. The primary risk factors include:

• A “deficient aortic rim”: To sit securely without rubbing, the closure device needs enough surrounding heart tissue to grip. If there is very little tissue (usually less than 5 millimeters) between the hole in your heart and the aorta (the main artery leaving the heart), the device may rest directly against the aorta, increasing the risk of friction ^[6][10].
• Oversized devices: Using a device that is too large for the hole or the surrounding anatomy can create excess pressure and friction against the heart walls ^[6][11].
• Aortic root dilation: If the base of the aorta is wider than normal (dilated), it can sit closer to the device, increasing the chance of rubbing ^[6][12].

Your doctor will use imaging tools like a transesophageal echocardiogram (TEE) to measure your rims and surrounding structures carefully before deciding if a transcatheter closure is right for you ^[3][4]. Importantly, having a deficient rim does not automatically mean you cannot have the procedure; doctors often adapt by using specific sizing techniques or alternative devices, or they may recommend surgical closure instead ^[6][13].

How is it monitored?

Your care team will monitor you closely to ensure the device is sitting safely. Most cases of cardiac erosion happen very early—often within the first 72 hours after the procedure ^[14][1]. Before you are sent home from the hospital, you will have an echocardiogram (ultrasound of the heart) to confirm the device is stable and not causing any fluid buildup around the heart (pericardial effusion) ^[3].

You will also have follow-up echocardiograms at regular intervals (typically at 1 month, 6 months, and 1 year) ^[3][15]. While rare, erosion has been known to occur months or even years after the procedure, which is why attending your scheduled, long-term cardiology checkups is vital ^[1][16]. If your doctor suspects any issues during these checks, they can use advanced imaging like a 3D TEE or a Cardiac CT scan to get a highly detailed view of the device ^[4][17].

Symptoms to watch for

Because this complication can be dangerous, it is important to know the warning signs. You should seek emergency medical attention immediately if you experience:

• Sudden, severe chest pain ^[7][18]
• Unexplained shortness of breath (dyspnea) ^[18]
• Fainting, severe dizziness, or signs of a dangerous drop in blood pressure (hemodynamic instability) ^[7][3]

Having this knowledge shouldn’t make you live in fear, but rather empower you to act quickly if something feels wrong.