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Percutaneous Management of Left Atrial Appendage Perforation: Keep Calm and Think Fast

Giovanni Lorenzoni1, Pierluigi Merella, Paolo Pischedda

  • 1Ospedale San Francesco, Unità Operativa Complessa di Cardiologia, via Mannironi 1, Nuoro, Italy. giovannilorenzoni@alice.it.

The Journal of Invasive Cardiology
|October 31, 2018
PubMed

Insights

Left atrial appendage perforation during closure procedures can occur. This case highlights successful management of cardiac tamponade via device removal and pericardial drainage, avoiding surgery.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous left atrial appendage (LAA) closure is an alternative stroke prevention strategy for patients with atrial fibrillation.
  • Complications such as LAA perforation can occur during the diagnostic or closure phases of the procedure.

Observation:

  • An 83-year-old woman with permanent atrial fibrillation and high risk for thromboembolism and bleeding underwent elective percutaneous LAA closure.
  • During the procedure, the patient became hypotensive, and imaging revealed heart perforation with contrast leakage into the pericardial space, confirming cardiac tamponade.

Findings:

  • The cardiac tamponade was successfully managed by immediate release of the closure device and pericardial fluid evacuation.
  • This intervention effectively stabilized the patient and averted the need for emergent surgical intervention.

Implications:

  • This case underscores the importance of prompt recognition and management of LAA perforation during percutaneous LAA closure.
  • Non-surgical management, including device removal and pericardial drainage, can be effective in treating cardiac tamponade resulting from LAA perforation.
  • This approach offers a potentially life-saving alternative to surgery in select cases of procedural complications.

Keywords:
cardiac imagingcardiac tamponadeheart perforationleft atrial appendage closure

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