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

Abstract

We present a rare case of thrombus adhering to the puncture site of the atrial septum during left atrial appendage closure. By discussing the case, we suggest that some preventive measurements be taken during left atrial appendage closure and that conventional transesophageal echocardiography for the atrial septal puncture site be performed after the delivery sheath is removed.

The point of no return for percutaneous left atrial appendage closure: Towards to CHA2DS2‐VALAAc Score?

“…Anticoagulation should promptly be resumed when DRT is detected to potentially decrease the risk of subsequent ischemic stroke . Even if the majority of patients with DRT (74%) do not experience stroke or systemic embolism, indeed, it converts the patients with “contraindication to anticoagulation” to patients with “anticoagulation‐dependent” situation . Similar to asymptomatic cerebral emboli following left atrial procedures, neurological imaging with brain magnetic resonance imaging after LAAc procedures may help clarify the impact of DRT in these patients .…”

“…However, AF has been now accepted as a risk marker for stroke rather a risk factor for ischemic stroke . It is clear that there is an unmet need for stroke prevention in patients unable to take anticoagulation but it is also unclear if LAAc devices would be the right option in these patients because of its invasive nature . The postprocedural antithrombotic regimens were not uniform in most non‐RCTs and the DOAC data were limited.…”