Emergency Surgical Retrieval of a Migrated Left Atrial Appendage Occlusion Device

Gupta, Prity; Szczeklik, Michał; Selvaraj, Andrew Dheepak; Lall, Kulvinder

doi:10.1111/jocs.12038

Cited by 15 publications

(10 citation statements)

References 6 publications

(9 reference statements)

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“…Finally, a total of 20 studies reporting 31 cases of device embolization were identified including 2 multi‐center randomized trials, 4 multi‐center registries, 6 single‐center registries and 9 case reports. There were 13 reported cases with WM and 18 cases with ACP . Studies reporting embolization of WM and ACP are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug

Aminian

Lalmand

Tzikas

et al. 2015

Cathet Cardio Intervent

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Section: Resultsmentioning

confidence: 99%

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug

Aminian

Lalmand

Tzikas

et al. 2015

Cathet Cardio Intervent

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“…Device dislodgement in association with embolization is a rare complication of LAA occlusion procedures . In most reported cases, the exact cause of device dislodgement is not mentioned.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence varies from 0 to 5.4% and in most larger series, the prevalence remains low (<2%) . Despite its uncommon occurrence, it is of utmost importance to avoid this potential complication since majority of the patients required surgical retrieval . There is a scarcity of literature in reporting the technique of percutaneous retrieval of dislodged LAA occlusion device.…”

Section: Introductionmentioning

confidence: 99%

Successful percutaneous retrieval of a dislodged left atrial appendage occlusion device with double transseptal sheaths and biopsy bioptome

Chan¹,

Choy²,

Lau³

2014

Cathet Cardio Intervent

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A 64-year-old woman underwent left atrial appendage occlusion with an Amplatzer Cardiac Plug device. Displacement of the device was detected on day 1 with transesophageal echocardiographic checking. The device became dislodged and flitted in the left atrium after unsuccessful retrieval with a snare and 12 Fr steerable transseptal sheath. A double transseptal sheath technique was then attempted. The flitting device was stabilized by one 12 Fr steerable transseptal sheath and successfully retrieved with a biopsy bioptome through another similar transseptal sheath. The patient suffered from no long-term sequelae.

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“…2 Although device embolization into the aorta or the left atrium is usually asymptomatic and can be managed by percutaneous retrieval, embolization in the LV cavity is a more serious complication, which usually requires surgical retrieval. 3,4 To the best of our knowledge, this is the first report of delayed embolization of a LAA closure device resulting in fatal outcome. Several important aspects of this case deserve comments.…”

Section: Discussionmentioning

confidence: 83%

Delayed and Fatal Embolization of a Left Atrial Appendage Closure Device

Aminian

Chouchane

Compagnie

et al. 2014

Circ: Cardiovascular Interventions

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A 78-year-old woman with permanent atrial fibrillation was referred to our institution for percutaneous left atrial appendage (LAA) occlusion. The patient had a high thromboembolic risk based on a CHA2DS2-VASc score of 8 and was on oral anticoagulant therapy with rivaroxaban at a dose of 20 mg/d. Because of major postural instability, the patient experienced recurrent falls with subsequent large and disabling superficial hematomas. The HAS-BLED score was 4. The procedure was performed under general anesthesia and with transesophageal echocardiogram guidance. After transseptal puncture, a 5-Fr multipurpose catheter was used to engage and inject the LAA. The maximal diameter of the ostium and the landing zone of the LAA were measured at 22 and 25 mm using transesophageal echocardiogram ( Figure 1A) and at 22 and 21 mm using angiography ( Figure 1B). Based on these measurements, we estimated an average diameter of the landing zone of 23 mm and we decided to implant a 26-mm Amplatzer Cardiac Plug (ACP; St. Jude Medical).After device deployment, all criteria of correct implantation were checked. Adequate compression of the device lobe was noted with a good separation between the device lobe and the disc. The device lobe was aligned with the neck of the appendage (Figure 2A) and more than two third of the device lobe was located distal to the circumflex artery ( Figure 2B). Finally, we applied a slight tension on the delivery cable (wiggle test), which confirmed device stability ( Figure 2C). The ACP was then released by removing the delivery cable. The patient experienced no procedural complication and was discharged the following day after control transthoracic echocardiogram showing no pericardial effusion and the absence of device dislodgement. Dual antiplatelet therapy with aspirin and clopidogrel was given, and a transesophageal echocardiogram control was planned at 6 weeks. One month after the procedure, the patient was readmitted to our institution, out of working hours, for acute dyspnea at rest and severe hypotension. Chest radiograph disclosed major pulmonary edema, and (Circ Cardiovasc Interv. 2014;7:628-630.)

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Emergency Surgical Retrieval of a Migrated Left Atrial Appendage Occlusion Device

Cited by 15 publications

References 6 publications

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug

Successful percutaneous retrieval of a dislodged left atrial appendage occlusion device with double transseptal sheaths and biopsy bioptome

Delayed and Fatal Embolization of a Left Atrial Appendage Closure Device

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