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Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

Mario Salido1, Marc Soriano1, Estefanía Fernández-Peregrina2

  • 1Cardiology Residency, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Left atrial appendage occlusion can lead to severe mitral regurgitation if the device migrates. Percutaneous retrieval of the migrated occluder and subsequent mitral valve repair were successfully performed in this case.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Recurrent stroke despite anticoagulation necessitates alternative preventative strategies.
  • Left atrial appendage occlusion (LAAO) is an established method for stroke prevention in atrial fibrillation.
  • New oral anticoagulants (NOACs) are standard therapy, but some patients require adjunctive or alternative treatments.

Observation:

  • A patient developed severe acute mitral regurgitation following LAAO.
  • The mitral regurgitation was attributed to the migration of the LAAO device.
  • The migrated device lodged in the descending aorta.

Findings:

  • Percutaneous retrieval of the migrated LAAO device from the descending aorta was successfully performed via a femoral artery approach.
  • Surgical mitral valve repair was subsequently required and successfully completed.
  • This case highlights a rare but serious complication of LAAO.

Implications:

  • Awareness of potential LAAO device migration and subsequent complications like mitral regurgitation is crucial for clinicians.
  • Multidisciplinary management involving interventional cardiology and cardiac surgery is essential for addressing such complex cases.
  • Further research into LAAO device design and deployment techniques may help mitigate migration risks.

Keywords:
AF, atrial fibrillationLAAO, left atrial appendage occlusionOAC, oral anticoagulantTOE, transesophageal echocardiographyacute heart failureatrial fibrillationmitral valvestroke

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