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Updated: May 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage occlusion
Ahmad Mirdamadi1, Mohsen Mirmohammadsadeghi, Farzad Marashinia
1Department of Cardiology, Najaf Abad Branch, Islamic Azad University, Isfahan, Iran.
Insights
Left atrial appendage occlusion prevents clots but can be misdiagnosed post-surgery. Accurate patient history is crucial to differentiate between a clotted and obliterated appendage, avoiding unnecessary treatments.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Left atrial appendage (LAA) occlusion is a key strategy to prevent thromboembolism, particularly in patients with severe mitral stenosis undergoing percutaneous trans-luminal mitral commissurotomy (PTMC).
- Trans-esophageal echocardiography (TEE) is standard for excluding LAA thrombus before PTMC.
- LAA occlusion can also be performed during mitral valve surgery.
Observation:
- A 49-year-old woman underwent mitral valve replacement and LAA occlusion.
- Post-operatively, echocardiography suggested a thrombus in the LAA, despite no pre-operative evidence on TEE.
Findings:
- The post-operative echo finding mimicked a thrombus but was likely an artifact of the obliterated LAA from surgery.
- This highlights the potential for misdiagnosis of LAA thrombus after mitral valve procedures.
Implications:
- Accurate patient history, including prior mitral valve surgery, is vital for correct LAA assessment.
- Avoiding misdiagnosis prevents unnecessary anticoagulation and delayed or inappropriate interventions.
- This case underscores the importance of integrating procedural history with imaging findings in clinical decision-making.
Abstract:
Left atrial appendage (LAA) occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC), it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC) and mitral valve replacement (MVR) too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS) and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.
