Ischemic Complications in a Patient With Spontaneous Echo Contrast Undergoing Percutaneous Left Atrial Appendage...

Left atrial appendage closure (LAAC) is a safe procedure. However, clinically silent brain ischemic lesions occur in 30% of patients, and device-related thrombosis (DRT) in up to 8%.

The current case describes an 87-year-old female who underwent LAAC because of bleeding complications related to anticoagulation therapy. A Watchman FLX (Boston Scientific) was successfully implanted. Periprocedural transesophageal echocardiography (TEE) revealed spontaneous echo contrast in the left atrium. At 30-day follow-up TEE, a large DRT was detected, and oral anticoagulation was restarted. Serial TEEs performed during extended follow-up showed gradual resolution of the thrombus. The patient also underwent serial periprocedural magnetic resonance that documented occurrence of 5 new brain ischemic lesions.

This case shows that spontaneous echo contrast present in the left atrium can potentially result in increased risk of thrombotic complications after LAAC such as new brain ischemic lesions or DRT.