Pulmonary artery perforation caused by a left atrial appendage closure device

Lu, Cong; Zeng, Jie; Meng, Qingguo; Zeng, Zhi

doi:10.1002/ccd.28541

Cited by 10 publications

(8 citation statements)

References 6 publications

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“…This finding suggests an awareness of especially flexible operation and a relatively lower device compression ratio in patients with elevated PASP undergoing LAAO (39). Compared with the Amplatzer Cardiac Plug, the Watchman device with shorter barbs and smaller penetration depth is considered to be safer for patients with elevated PASP.…”

Section: Discussionmentioning

confidence: 91%

Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion

Zou¹,

Chen²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Patients with nonvalvular atrial fibrillation (NVAF) undergoing left atrial appendage occlusion (LAAO) are at high risk of stroke or bleeding. However, risk factors for their adverse cardiovascular events remain largely unknown. Pulmonary hypertension has been shown to be related to poor prognosis in many heart diseases. In this study, we determined whether elevated pulmonary artery systolic pressure (PASP) is associated with postprocedure adverse events and major adverse cardiovascular events (MACE) in these patients.Methods: From June 2017 and December 2019, 530 consecutive patients with NAVF at high risk of stroke or bleeding who undergone LAAO were retrospectively enrolled in our study. The preprocecure PASP was obtained by transthoracic echocardiography using the simplified Bernoulli's equation. Patients were followed-up through clinic visits or over the phone at discharge at 1-3 months, 6 months, and annually thereafter. The median follow-up time was 12 months, and clinical data were analyzed. MACE was defined as myocardial infarction, definite heart failure, stroke, or all-cause death. The outcome of postprocedure pericardial effusion included in-hospital pericardial effusion and pericardial effusion detected after discharge.Results: Univariate analyses indicated that patients who had MACE tended to have elevated PASP (P=0.005). After dividing the cohort according to the cut-off value of PASP, Kaplan-Meier curves indicated that patients with PASP ≥39.5 mmHg had a higher risk of MACE (P=0.007) and heart failure hospitalization (P=0.005) compared to patients whose PASP <39.5 mmHg. Cox regression analysis showed that PASP was a predominant risk factor of MACE (HR =2.337, 95% CI, 1.207-4.526, P=0.012) and heart failure hospitalization (HR =3.701, 95% CI, P=0.032). Furthermore, the PASP cut-off added incremental discriminatory capacity to the MACE risk model of this cohort. In addition, logistic regression showed that PASP had as a significant association with postprocedure pericardial effusion (OR =1.061, P=0.032).Conclusions: Elevated PASP was associated with postprocedure pericardial effusion and mid-term MACEs in patients with atrial fibrillation (AF) undergoing LAAO.

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Section: Discussionmentioning

confidence: 91%

Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion

Zou¹,

Chen²,

Zhang³

et al. 2021

Ann Transl Med

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show abstract

“…7 Other reports have described the use of fluoroscopy to visualize contrast transit from cardiac chambers to the pericardium through a perforation. [8][9][10] However, to our knowledge, this report is the first to publish images of color Doppler identification and surveillance to resolution of active LAA-to-pericardial flow.…”

Section: Discussionmentioning

confidence: 93%

Vital Role of Transesophageal Echocardiographic Surveillance of a Left Atrial Appendage Perforation Complicating Attempted Percutaneous Appendage Occlusion

Zitelny

Brunetti

Singleton

et al. 2021

CASE

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“…For example, in 224 AF patients who underwent LAAC with LAmbre, the use of the modi ed LAmbre release technology reduced, but did not entirely avoid, the occurrence of pericardial effusion/CT; the incidence of delayed CT was 2.2% (5/224 cases) [18]. In an analysis of case reports of CT after LAAC in which pericardial puncture and drainage were ineffective and emergency thoracotomy was performed, most cases were caused by puncture of the PA walls by the anchor hook from the adjacent LAA [19][20][21][22][23], and even PA perforation and air embolism led to fatal outcomes [24]. In addition, there are also reports of the device lobe and disc eroding the left atrium/LAA wall or the junction of the left superior PV or causing CT by lacerating the left coronary circum ex branch wall [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Delayed cardiac tamponade in atrial fibrillation patients with left atrial appendage closure

Yuan¹,

Ning²,

Hu³

et al. 2022

Preprint

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Background: We sought to investigate the relationship of delayed cardiac tamponade (CT) after left atrial appendage closure (LAAC) in patients with atrial fibrillation (AF) and identify the adjacent anatomical structures. Methods: This retrospective and cross‐sectional study enrolled AF patients with LAAC complicated by delayed CT with concurrent emergency pericardiocentesis drainage who were seen at Zhoupu Hospital affiliated with the Shanghai University of Medicine and Health Sciences from August 2016 to June 2021. The mean follow-up time was 16 ± 12 months, and clinical data, including the relationship between the left atrial appendage and pulmonary artery and the vein anatomy revealed left atrium computed tomography angiography (CTA) before and after LAAC, were retrospectively analyzed. Results: Thirteen patients (mean age, 72.1 ± 8.3 years; seven men) in whom delayed CT was treated by pericardiocentesis and drainage after LAAC, including six patients with LAAC simultaneous cryoablation, were enrolled. Eight LAAs were of the cauliflower type, and five were of the chicken wing type. The seal plate diameter of the lobe-and-disc devices was 29.5 ± 2.8 mm. Ten patients with cardiac computed tomography angiography images were reviewed: the occluder was attached to a pulmonary artery in eight patients, to the left superior pulmonary vein only in one patient, and to the pulmonary artery and left superior pulmonary vein in one patient. One patient died 2 days after LAAC, and other 12 patients had a good prognosis. Conclusions: The anatomic relationship of the left atrial appendage, pulmonary artery, and left superior pulmonary vein was related to delayed CT after LAAC; the larger occluder and its anchor hook structure facilitated the occurrence of delayed CT.

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Pulmonary artery perforation caused by a left atrial appendage closure device

Cited by 10 publications

References 6 publications

Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion

Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion

Vital Role of Transesophageal Echocardiographic Surveillance of a Left Atrial Appendage Perforation Complicating Attempted Percutaneous Appendage Occlusion

Delayed cardiac tamponade in atrial fibrillation patients with left atrial appendage closure

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