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Emergency surgical retrieval of a migrated LAmbre device through the mitral valve
Daniel Martinez-Lopez1, Juan Esteban de Villarreal Soto1, Victor Manuel Ospina Mosquera1
1Cardiac Surgery Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Insights
Left atrial appendage occlusion is a safe alternative to anticoagulation for atrial fibrillation. A rare complication involved a migrated LAmbre device causing severe mitral valve issues, necessitating emergency surgery and valve replacement.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Complications
Background:
- Left atrial appendage occlusion (LAAO) offers an alternative to long-term anticoagulation for non-valvular atrial fibrillation (NVAF).
- While generally safe, LAAO procedures carry risks of serious complications, including device embolization and cardiac tamponade.
Observation:
- A case report details a LAmbre device migrating four days post-implantation in a patient with NVAF.
- The occluder became entrapped within the mitral valve, leading to secondary massive mitral regurgitation and severe stenosis.
Findings:
- The mitral valve damage and hemodynamic instability necessitated emergency surgical intervention.
- Successful device removal was achieved, but extensive damage to the anterior leaflet and chordae required mitral valve replacement.
Implications:
- This case highlights a rare but severe complication of LAAO, emphasizing the need for vigilant monitoring post-procedure.
- It underscores the potential for device migration and subsequent valvular damage, impacting patient outcomes and management strategies.
Abstract:
Left atrial appendage occlusion has become an alternative for long-term anticoagulation for patients with non-valvular atrial fibrillation. Although the procedure is safe, life-threatening complications such as embolization of the device or cardiac tamponade might occur. We present a case of a LAmbre device that migrated 4 days after being implanted and remained trapped in the mitral valve. Secondary massive mitral regurgitation with severe stenosis and haemodynamic instability required emergency surgery. The device was successfully removed, but severe damage in the anterior leaflet and chords forced a valve replacement.
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