Thrombus‐in‐Transit Following Watchman Device Implantation

Abstract

Thrombus-in-transit crossing an interatrial communication is a rare but potentially serious clinical condition, which has so far not been described after implantation of left atrial appendage (LAA) closure devices. Here, we describe the case of a 76-year-old woman with permanent atrial fibrillation and contraindication for oral anticoagulation therapy, who developed pericardial tamponade and acute pulmonary embolism with visible thrombus-in-transit formation following LAA closure. Most likely manipulation of the Watchman device in the LAA during two failed attempts in device positioning led to pericardial tamponade and venous puncture, manual compression after completion of the procedure and further immobilization resulted in deep vein thrombosis with consecutive pulmonary embolism and thrombus-in-transit formation. This case highlights the value of echocardiography after LAA closure.

Watch out for the Thrombus Adhering to the Puncture Site of the Atrial Septum during Left Atrial Appendage Closure

“…Large sheaths and longer procedural times are the main risk factors for the formation of deep venous thrombosis. 12) Wallenborn, et al 13) have reported a case of postoperative thrombus-in-transit originating from deep vein thrombosis, which led to pulmonary embolism, and they have advised vigilance to the occurrence of such incidents after LAAC, particularly when using large bore introducers during the surgery. To the best of our knowledge, thrombi adhering to the puncture site of the right atrial septum formed during LAAC without causing severe thromboembolic events are rarely reported, and this may be the first such case to be reported.…”