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Image in Cardiology
Embolization of a left atrial appendage closure device
Embolização de dispositivo de encerramento do apêndice auricular esquerdo
Alzira Nunesa,
Autor para correspondência
zira.nunes.2@gmail.com

Corresponding author.
, Diana Pissarrab, Marta Tavares Silvaa,c, Pedro Bernardo Almeidaa, João Carlos Silvaa, Maria Júlia Maciela,c
a Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
b Serviço de Cirurgia Cardiotorácica, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
c Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 68-year old hypertensive man with diabetes and a history of persistent atrial fibrillation and an ischemic cerebral event&#44; was referred for percutaneous left atrial appendage &#40;LAA&#41; closure&#46; He was at high thromboembolic risk based on a CHA2DS2-VASc score of five and oral anticoagulants were contraindicated due to a firearm-related brain injury&#46; A pre-procedure transesophageal echocardiogram &#40;TOE&#41; showed a LAA compatible with percutaneous closure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; It was performed under general anesthesia and with TOE guidance&#46; After transseptal puncture&#44; a windsock-shaped LAA with a landing zone of 31 mm was observed on fluoroscopy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Based on TOE and fluoroscopy measurements&#44; a 34-mm Amplatzer Amulet device was chosen and deployed in the LAA with a residual leak of 3 mm&#46; Once in place&#44; device stability was confirmed&#58; tire shape of the lobe&#44; concavity of the disk and good separation of the lobe from the disk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>-A&#41;&#59; device lobe was aligned with appendage neck and more than two thirds of the device lobe was located distal to the circumflex artery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B and C&#41;&#46; The next day&#44; he was asymptomatic and hemodynamically stable&#44; however&#44; a routine chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A&#41; and transthoracic echocardiogram &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B and C&#41; showed embolization of the LAA device into the left ventricular outflow tract&#44; without impairment of mitral valve function&#46; Because of the risk of damage to the aortic and mitral valves by the device unfolded anchoring barbs&#44; urgent surgical device removal &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41; and appendage amputation was the first line strategy and the procedure was uneventful&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram &#40;A&#41; and fluoroscopy &#40;B&#41; images showing the diameter of the left atrial appendage at the landing zone &#40;yellow lines&#41; 10 mm inside the left atrial appendage orifice &#40;gray lines&#41;&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopy &#40;A&#41; and transesophageal echocardiogram &#40;B and C&#41; images showing correct Amplatzer Amulet device implantation in the left atrial appendage &#40;arrows&#41;&#46; CX indicates circumflex artery&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral chest X-ray view &#40;A&#41; and two-dimensional transthoracic echocardiogram parasternal long-axis &#40;B&#41; and apical four-chamber &#40;C&#41; views revealing embolized device in the left ventricle outflow tract &#40;arrows&#41;&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intraoperative image &#40;A&#41; shows the embolized left atrial appendage closure device being removed from the left ventricular outflow tract just below the aortic valve plane&#46; Extraoperative images &#40;B and C&#41; showing the removed device&#46;</p>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2019.12.010
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