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Published on: February 28, 2012
Left Atrial Appendage Occlusion Device Placement Aborted Because of Coronary Artery Bypass Graft
John Yin1, Garret Hillsdon-Smith1, Zachary J Rhinehart2
1Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Left atrial appendage occlusion device implantation can be difficult in patients with prior coronary artery bypass grafting. A planned procedure was aborted due to an anomalous bypass graft adhered to the left atrial appendage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Patients undergoing LAAO may have a history of coronary artery bypass grafting (CABG), presenting unique anatomical challenges.
Purpose of the Study:
- To report a case where LAAO device implantation was complicated by an anomalous coronary artery bypass graft.
Main Methods:
- A case report detailing the intraprocedural findings during a scheduled LAAO implantation.
- Intracardiac echocardiography or transesophageal echocardiography may be used to visualize anatomical structures.
Main Results:
- The LAAO implantation procedure was aborted due to an unexpected finding.
- An anomalous course of a bypass graft was observed, appearing adherent to the left atrial appendage, posing a significant risk for device deployment.
Conclusions:
- Anomalous coronary artery bypass grafts can pose a significant challenge and risk during LAAO procedures.
- Careful pre-procedural imaging and awareness of potential anatomical variations are crucial in patients with prior CABG undergoing LAAO.
Abstract:
Left atrial appendage occlusion device (LAAO) implantation among patients who have had coronary artery bypass grafting can be challenging. We report a case of scheduled LAAO device implantation that was aborted due to the anomalous course of a bypass graft that appeared to be adherent to the left atrial appendage. (Level of Difficulty: Intermediate.).
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