Non-valvular atrial fibrillation (NVAF) is the most common cause of cardioembolic stroke. The left atrial appendage (LAA) is the major source of cardiac emboli in patients with NVAF. Anticoagulation (AC) is the standard of care for stroke prevention in atrial fibrillation (AF), but many patients are intolerant of AC. Surgical exclusion of the LAA may result in incomplete closure and is associated with an increased risk of embolism. We report a case of a woman in her 50s with a history of persistent AF, mitral valve prolapse s/p repair with surgical LAA exclusion, and multifocal haemorrhagic stroke presented for elective LAA closure who underwent a Watchman placement successfully. This case demonstrates that a percutaneous approach for occlusion of the LAA when surgical exclusion was incomplete may be feasible with appropriate planning. Clinical outcome data for this patient group are needed.
Takotsubo cardiomyopathy (TTC) is also known as stress-induced cardiomyopathy and mimics acute coronary syndrome in the setting of non-obstructive coronary artery disease. It is associated with reversible left ventricular apical, mid, and/or basal wall motion abnormalities. A coronary artery fistula (CAF) is a connection between one or more of the coronary arteries and the cardiac chamber or great vessel. We present a case of an elderly woman who presented with chest pain and was found to have non-obstructive coronary artery disease with wall motion abnormality pattern consistent with TTC and multiple CAF involving the left circumflex coronary artery and pulmonary artery. This case highlights a rare association between two uncommon entities.
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