左心耳残存による左房内遊離血栓症:胸腔鏡下左心耳閉鎖術の合併症
Motoki Nagatsuka1, Tohru Asai1, Kenichiro Noguchi1
1Department of Cardiovascular Surgery, Shonan Kamakura General Hospital.
Abstract:
A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced three cerebral infarctions and underwent thoracoscopic left atrial appendage closure (LAAC). 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 LAAC may help mitigate the risk of thrombus formation.
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