Giant Left Atrial Appendage and Coronary Fistula With Microvascular Remodeling After Surgical Closure
Yuki Ikeshita1, Yojiro Machii2, Hideaki Kanzaki1
1Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Osaka, Suita, Japan.
Insights
Left atrial appendage (LAA) closure can lead to rare but serious complications like giant LAA enlargement and coronary-LAA fistulae. Surgical LAA resection may be necessary in complex cases, highlighting the need for vigilant monitoring post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Left atrial appendage (LAA) closure is a strategy to reduce stroke risk in patients with atrial fibrillation.
- Complications following LAA procedures, though uncommon, require thorough investigation.
Background:
Left atrial appendage (LAA) closure reduces stroke in patients with atrial fibrillation.
Case Summary:
A 63-year-old man with chronic atrial fibrillation had undergone mitral valve replacement and endocardial suture closure of the LAA 5 years before presentation. One year postoperatively, a giant LAA was noted, and coronary angiography revealed a newly developed coronary-LAA fistula. Progressive enlargement of the LAA was confirmed 5 years postoperatively, with expansion of the fistulous tract on coronary angiography, ultimately leading to surgical LAA resection.
Discussion:
Incomplete suture closure might have caused microscopic residual flow and thrombus formation within the LAA despite anticoagulation. Additionally, we speculate that the fistula developed from postoperative microvascular remodeling, potentially serving as a pathway for blood flow into the LAA. LAA resection may represent a reasonable option in selected cases.
Take-Home Message:
Postclosure LAA enlargement, though rare, warrants evaluation for coronary-LAA fistulae because reintervention may be required.
