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Delayed coronary artery stenosis: a rare complication of the left atrial clipping device

Yuki Imamura1, Ryosuke Kowatari1, Tomonori Kawamura1

  • 1Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|November 10, 2023
PubMed

Insights

A left atrial appendage clipping device can rarely cause coronary artery stenosis, leading to cardiac events months after surgery. Early or delayed detection and intervention, including clip removal, are crucial for patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Left atrial appendage occlusion is a common procedure to prevent stroke in patients with atrial fibrillation.
  • Clipping devices are used for left atrial appendage occlusion.
  • Coronary artery impingement by these devices is a rare but serious complication.

Purpose of the Study:

  • To report a rare case of delayed coronary artery stenosis due to a left atrial appendage clipping device.
  • To emphasize the potential for late-onset complications following left atrial appendage clipping.
  • To highlight the importance of anatomical considerations in device placement.

Main Methods:

  • Case report of a patient experiencing delayed cardiac ischemia after left atrial appendage clipping.
  • Percutaneous coronary intervention (PCI) for stenosis.
  • Surgical clip removal.
  • Postoperative 3D heart model analysis to assess anatomical risk factors.

Main Results:

  • Delayed severe coronary artery stenosis occurred 2 months post-surgery, leading to ventricular fibrillation.
  • Successful percutaneous coronary intervention and subsequent clip removal.
  • 3D modeling revealed an unusually dorsal left atrial appendage base, increasing impingement risk.

Conclusions:

  • Left atrial appendage clipping devices can cause delayed coronary artery stenosis.
  • This rare complication can manifest weeks or months after the initial procedure.
  • Anatomical variations, such as a dorsal appendage base, may increase the risk of coronary artery impingement.

Keywords:
Atrial appendageCoronary stenosesSurgery

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