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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Left Atrial Thrombus after Transcatheter Mitral Edge-to-edge Repair in a Patient with Left Appendage Occlusion

Kyoko Unno1, Hayato Ohtani1, Atsushi Sakamoto1

  • 1Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan.

Internal Medicine (Tokyo, Japan)
|November 27, 2024
PubMed

Insights

Transcatheter edge-to-edge repair (TEER) for mitral regurgitation can lead to unexpected left atrial (LA) thrombus formation, even after left atrial appendage occlusion (LAAO). This case underscores the importance of vigilant monitoring for thrombosis post-TEER.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Heart failure (HF) management often involves addressing mitral regurgitation (MR).
  • Transcatheter edge-to-edge repair (TEER) is an established treatment for severe functional MR.
  • Left atrial appendage occlusion (LAAO) is used to prevent stroke in patients with atrial fibrillation.

Purpose of the Study:

  • To report a case of subacute left atrial (LA) thrombosis after successful TEER.
  • To discuss potential mechanisms contributing to thrombus formation post-TEER.
  • To emphasize the need for vigilance regarding LA thrombosis in patients undergoing TEER, even with prior LAAO.

Main Methods:

  • Case report of a 67-year-old male patient with HF, atrial fibrillation, and prior LAAO.
  • Patient underwent TEER for severe functional MR.
  • Postoperative echocardiography revealed a large LA thrombus.

Main Results:

  • Successful TEER was performed.
  • A large LA thrombus was unexpectedly discovered on postoperative day 3.
  • Potential causes include altered LA hemodynamics, septal puncture endothelial injury, and inadequate anticoagulation.

Conclusions:

  • Subacute LA thrombosis is a potential complication following TEER.
  • Prior LAAO does not preclude the development of LA thrombosis post-TEER.
  • Careful monitoring and optimized anti-thrombotic strategies are crucial after TEER.

Keywords:
left atrial appendage closureleft atrial thrombusmitral regurgitationtranscatheter edge-to-edge repair

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