Venous color Doppler of the lower extremities showed considerable thrombosis in the right femoral vein (Fig.3). long-term results [10]. Despite this fact, some catastrophic complications, including systemic embolization, total atrioventricular block, and cardiac perforation, have been known to occur during the perioperative period of transcatheter ASD closure [4]. In this article, we present the case of a 4-year-old lady who experienced a cryptogenic stroke secondary to a presumptive paradoxical embolism (PDE) after an unsuccessful attempt to close an ASD with a transcatheter process and in whom subsequent venous color Doppler showed deep venous thrombosis of the Danoprevir (RG7227) right lower extremity. == Case Statement == A 4-year-old lady was referred for transcatheter closure of a secundum-type ASD at Danoprevir (RG7227) our catheter room because of recurrent upper respiratory tract infections. Her total body weight was 14.9 kg, and her height was 96 cm. Her cardiac examination was notable for a normal S1 and fixed splitting of S2 with a grade III/VI Danoprevir (RG7227) systolic ejection murmur heard at the left upper sternal border. Her electrocardiogram showed a sinus rhythm with an incomplete right bundle branch block. Chest X-ray showed mild cardiomegaly with increased pulmonary vascular markings. Transthoracic echocardiography demonstrated a secundum ASD measuring approximately 16.2 mm in diameter with left-to-right shunting, right atrial and ventricular enlargement, and adequate rims that appeared to be suitable for percutaneous transcatheter closure (Fig.1). After written informed consent was obtained from the patients parents, a transcatheter ASD closure procedure was attempted with the patient under general anesthesia. Venous access was obtained from the right femoral veins using a 6F sheath. At the start of the procedure, a bolus of weight-adjusted heparin (100 IU/kg) was administered intravenously. Cardiac catheterization showed mean right atrial pressure of 7 mmHg with A wave of 12 mmHg and V wave of 10 mmHg and main pulmonary artery pressure of 29/10 mmHg. Oximetry showed a left-to-right shunt at the atrial level with a calculated pulmonary to systemic flow ratio of 1 1.8:1. A 24 mm Amplatzer septal occluder (ASO; AGA Medical, Golden Valley, MN) was advanced by way of a 10F AGA delivery sheath. During deployment of the occluder, the left atrial disc was easily prolapsed into the right atrium. The device was recaptured, and multiple attempts at deploying the occluder failed. Because the stretched diameter of the atrial septum was 40 mm, the Danoprevir (RG7227) application of a larger ASO device could interfere with other important intracardiac structures. Moreover, the size of the left atrial cavity might not be sufficient to accommodate the expanded left atrial disc of a larger device. Therefore, the procedure was abandoned after a total procedure time of 62 min. After the procedure, neither aspirin nor heparin was administered to the patient. == Fig. 1. == Transthoracic echocardiography demonstrated a secundum ASD with left-to-right shunting On postoperative day 1, the patient was noted to have sudden onset of slurred speech and right-limb movement disorder. On clinical examination she was found to have expressive aphasia and right-sided hemiplegic paralysis. Cerebral magnetic resonance imaging (MRI) demonstrated lesions of acute infarction in the leftward hippocampus, basal ganglia, and temporal lobe area (Fig.2). Transthoracic echocardiogram was performed to rule out any cardioaortic source of embolism, which confirmed that all cardiac chambers were clear of thrombus. On chest computed tomography scan, there was no evidence of pulmonary embolism. Venous color Doppler Danoprevir (RG7227) of the lower extremities showed extensive thrombosis in the right femoral vein (Fig.3). Laboratory evaluation showed that protein C, protein S, activated protein C resistance, antithrombin III, homocysteine, and anticardiolipin antibody were normal. == Fig. 2. == Brain MRI showed acute cerebral infarctions in the leftward hippocampus, basal ganglia, and temporal lobe area (arrows) == Fig. 3. == Venous color Doppler of the lower extremities showed DVT of Smcb the right femoral vein (arrow) On the basis of these findings, PDE was thought to be responsible for the systemic neurological deficits. The patient was anticoagulated with titrated doses of warfarin and commenced aspirin at 50 mg daily. Repeat venous Doppler examination of the right lower extremity performed 15 days later showed no residual thrombus in the right femoral vein..