Stroke in a patient with a surgically ligated left atrial appendage: should warfarin be continued after left atrial...

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• The left atrial appendage is a common source of thromboembolism, particularly in patients with atrial fibrillation.
• Surgical ligation of the left atrial appendage is performed to reduce stroke risk during cardiac procedures.

Observation:

• A 74-year-old woman experienced embolic stroke affecting the brainstem and cerebellum.
• Past medical history included coronary bypass surgery with prophylactic left atrial appendage ligation.

Findings:

• Investigations revealed the source of emboli was an incompletely ligated left atrial appendage.
• This anatomical anomaly led to recurrent clot formation and subsequent embolism.

Implications:

• Incomplete left atrial appendage ligation poses a significant risk for embolic events.
• Post-operative anticoagulation management is crucial to mitigate embolism risk after cardiac surgery.
• This case highlights the importance of complete surgical technique and vigilant anticoagulation strategies.