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Updated: Jun 18, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Interventional closure of an iatrogenic LAA-perforation by means of a PFO-occluder
Florian Genske1,2, Christoph Marquetand1,2, Tobias Schmidt1,2
1Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
Insights
A rare complication during left atrial appendage closure (LAAC) for atrial fibrillation stroke prevention led to cardiac arrest. An innovative interventional technique using a PFO occluder successfully sealed the perforation, saving the patient
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with a high risk of cardioembolic stroke.
- Left atrial appendage occlusion (LAAC) offers an alternative to oral anticoagulation for stroke prevention in AF patients.
- While generally safe, LAAC procedures can have rare but serious peri-interventional complications.
Observation:
- An 87-year-old patient undergoing elective LAAC developed a pericardial effusion, hemodynamic instability, and cardiac arrest post-device placement.
- The complication was attributed to a perforation of the left atrial appendage (LAA) by the occluder device.
- Immediate drainage of the pericardial effusion and cardiopulmonary resuscitation (CPR) were required.
Findings:
- A novel interventional approach was employed, utilizing a persistent foramen ovale (PFO) occluder device to seal the LAA perforation.
- This strategy successfully resolved the perforation and stabilized the patient's hemodynamic status.
- The patient recovered well and was discharged in good condition.
Implications:
- Serious procedural complications during LAAC, though rare, can be managed effectively with interventional strategies.
- Utilizing a PFO occluder to treat LAA perforation offers a life-saving alternative to traditional surgical intervention.
- This case highlights the potential for innovative device-based solutions in managing complex interventional cardiology complications.
Abstract:
Atrial fibrillation (AF) is the most common rhythm disorder with a high risk for cardioembolic strokes. Interventional occlusion of the left atrial appendage (LAA) is an alternative to the widely established stroke prevention with oral anticoagulation. Complications through LAA closure (LAAC) are rare and usually occur periinterventional. We present a case of an 87-year-old patient who presents for elective LAAC. After placement of the LAA occluder (Amplatzer Amulet device 25 mm) in the LAA and partial resheathing, the patient developed a pericardial effusion (PE), became hemodynamically unstable and went into cardiac arrest with the need for cardiopulmonary resuscitation (CPR). After drainage of the PE, we closed the causative LAA-perforation using a persistent foramen ovale (PFO)-occluder device (Amplatzer Talisman, 25 mm). Thereby we were able to successfully seal the perforation and stabilize the patient. The patient was monitored at our intensive care unit for 2 days and left the hospital in good condition a few days after. Procedural complications during interventional LAAC are rare but can be serious. The most common complication, PE, requires percutaneous drainage and often cardiac surgery. We present a case in which a perforation and following PE with hemodynamic relevance and need for CPR was resolved with an interventional strategy through implantation of a PFO-occluder into the perforation. With this approach we were able to show that in the right setting even serious complications can be treated by interventional measures, thereby not only saving the patient's life, but also avoiding cardiac surgery.
