Pulmonary artery perforation and coronary air embolism-two fatal outcomes in percutaneous left atrial appendage...

Area of Science:

• Cardiology
• Medical Device Technology
• Forensic Pathology

Background:

• Percutaneous left atrial appendage (LAA) closure is a standard procedure for stroke risk reduction in atrial fibrillation patients unsuitable for oral anticoagulation.
• The Amplatzer Amulet and Watchman systems are commonly used LAA occlusion devices.
• While generally safe with high acute success rates (>95%), potential complications include pericardial effusions, air embolism, vascular injury, and death.

Observation:

• This report details two rare fatal outcomes following percutaneous LAA occlusion.
• Case 1: A patient died 8 hours post-Amplatzer Amulet deployment due to pulmonary trunk perforation by a device hook, leading to pericardial tamponade.
• Case 2: A patient experienced immediate death due to coronary air embolism during Watchman device deployment following accidental air injection.

Findings:

• These cases illustrate extremely rare but catastrophic complications associated with LAA closure devices.
• Device-related perforation and procedural air embolism are identified as fatal mechanisms.
• Forensic autopsies are crucial for determining the exact cause of death and informing device improvement.

Implications:

• The findings underscore the importance of meticulous procedural technique and patient monitoring during LAA occlusion.
• Collaboration between cardiology and forensic pathology is essential for understanding rare adverse events.
• Further research into device design and deployment strategies may help mitigate such fatal risks.