Left circumflex coronary artery occlusion due to a left atrial appendage closure device

Abstract

A b s t r a c tNowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure. A B

Systematic Review of Contiguous Vessel and Valve Injury Associated with Endocardial Left Atrial Appendage Occlusion Devices

“…Comprehensive search revealed 12 publications from Asia, Europe, and Australia with description of 13 cases of contiguous vessels and mitral valve injury after LAAO [6][7][8][9][10][11][12][13][14][15][16][17] . The average age of the patients was 71.4 ± 8.2 years; 92% were Caucasians.…”

“…The common presentation was sudden hemodynamic collapse with evidence of pericardial tamponade [ Figure 2]. Less common contiguous vessel injuries included left inferior pulmonary vein compression due to atrial disc portion of ACP (10%) [6] as well as left circumflex coronary artery (LCX) compression by the lobe portion of the oversized ACP (10%) causing ST-segment elevation [9] . Pulmonary vein compression by ACP was diagnosed during a follow-up radiofrequency pulmonary vein isolation by low impedance in the ridge between left inferior pulmonary vein and LAA suggesting catheter contact with metal device.…”

Left atrial appendage occlusion device causing coronary obstruction: A word of caution

“…Only two cases of LAAO and circumflex artery occlusion have been reported, but both were recorded after thoracoscopic LAAO, where the overview of the anatomical structures can be compromised 3 . As the CX is one of the LAA neighboring structures, occlusion is possible 4 and CX stenosis following LAAO with percutaneous devices has been reported previously 5 . Here, the occlusion occurred with a 24 h delay after open‐heart surgery, where the visibility of the anatomical structures is excellent, and misplacement of the clip with following entrapment of the CX due to compromised overview seems unlikely.…”

“…3 As the CX is one of the LAA neighboring structures, occlusion is possible 4 and CX stenosis following LAAO with percutaneous devices has been reported previously. 5 edema is known to occur after cardiac surgery, especially after valve surgery, and responsible for disorders of the conduction system. We suppose that the combination of both the rigid ring and the clip may have caused edema in the tissue between the mitral valve annulus and the LAA, leading to kinking of the CX and delayed coronary stenosis.…”

Cardiac CT: A Sine Qua Non for Structural Heart Interventions

“…In many of these applications, it has proven superior to transthoracic (TTE) or transesophageal echocardiography (TEE), and in some cases, it has supplanted the need for pre-and intra-procedural TEE [8][9][10]. CTA can also reveal information about structures that are difficult to visualize with TEE, for example circumflex artery compression by a left atrial appendage occlusion device or erosion of an ASD closure device into adjacent structures [11][12][13]. These ad-vancements have been driven in large part by improved scanner technology and image resolution that allows dynamic and faster cardiac imaging with lower radiation and contrast doses than a decade ago.…”