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Large Free-Floating Left Atrial Thrombus After Incomplete Thoracoscopic Closure of the Left Atrial Appendage
Motoki Nagatsuka1, Tohru Asai1, Kenichiro Noguchi1
1Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Insights
Left atrial appendage closure (LAAC) for atrial fibrillation can lead to thrombus formation if the procedure is incomplete, especially with coexisting tricuspid regurgitation. Prompt surgical intervention and potential concomitant tricuspid valve repair may be necessary.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- A 79-year-old male patient with permanent atrial fibrillation and cardiomyopathy presented with recurrent cerebral infarctions despite anticoagulation.
- The patient had a history of an implantable cardioverter-defibrillator placement.
Abstract:
A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced 3 cerebral infarctions and underwent thoracoscopic left atrial appendage closure. Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at left atrial appendage closure may help mitigate the risk of thrombus formation.
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