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Updated: Jul 24, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure Device Embolization under the Anterior Leaflet of Mitral Valve: Echocardiographic
Fabrizio Ceresa1, Aurora Leonardi1, Filomena Bruna De Donno1
1Department of Thoracic and Cardiovascular Surgery, Papardo Hospital, Messina, Italy.
Insights
Device embolization during left atrial appendage closure required emergent surgery. A novel approach using cardiopulmonary bypass without aortic cross-clamping successfully retrieved the device, stabilizing the patient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous left atrial appendage closure is a common procedure for stroke prevention in atrial fibrillation.
- Complications such as device embolization can lead to severe hemodynamic compromise.
- Managing device embolization in patients with multiple comorbidities presents a significant clinical challenge.
Abstract:
A 76-year-old man with history of previous coronary artery bypass grafting, permanent atrial fibrillation in novel oral anticoagulation therapy, and gastrointestinal bleedings underwent percutaneous left atrial appendage closure. The procedure was complicated by intraoperative device embolization, which caused a dynamic obstruction of the left ventricular outflow tract leading to severe hemodynamic instability. Transesophageal echocardiography showed a device in the ventricle site of the mitral anterior leaflet. The coronary angiography showed also patency of both arterial grafts in stable coronary artery disease. After failing the percutaneous retrieval with a snare, emergent surgery was planned. A moderate calcified aortic valve stenosis was also found, but in consideration of the unstable clinical conditions of the patient, we thought of performing a transcatheter aortic valve replacement (TAVR) in a second time. We have carefully planned the surgical retrieval of the device embolized paying attention of his several comorbidities. The strategy to remove the device with cardiopulmonary bypass without cross-clamping the aorta through a right mini-thoracotomy has been preferred.
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