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Saleeb AG, Farina JM, Jenkins A, Zeineddine R, Shawwaf K, Yang EH, Alsidawi S, Jaroszewski DE, Downey FX. Surgical Removal of a Migrated WATCHMAN Device. Methodist Debakey Cardiovasc J 2024; 20:80-86. [PMID: 39247626 PMCID: PMC11378705 DOI: 10.14797/mdcvj.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/15/2024] [Indexed: 09/10/2024] Open
Abstract
The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
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Ye W, Zhou W, Zhao W, Mao J, Wang W, Wei L, Zhao L, Xu Y, Yu J, Fu Z, Wang Q, Zhang Z. Emergent surgical retrieval of a left atrial appendage occluder migrated into the left ventricular outflow tract with secondary massive mitral regurgitation: A case report and literature review. Heliyon 2024; 10:e27112. [PMID: 38449592 PMCID: PMC10915572 DOI: 10.1016/j.heliyon.2024.e27112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
Thrombotic complications of atrial fibrillation continue to pose a significant challenge in clinical practice today. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative to oral anticoagulation for high-risk patients with atrial fibrillation. However, despite the potential benefits, there is still the possibility of life-threatening complications such as device dislocation. In this case study, we present a patient who experienced severe hemodynamic disturbances due to the embolization of LAAO device into the left ventricular outflow tract, resulting in a torn mitral valve and secondary massive mitral regurgitation, just 3 hours after the procedure. As a result, emergent surgical intervention was required to remove the device and repair the mitral valve. We also conducted a review of previous studies on the retrieval of dislodged left atrial appendage occluders through surgical procedures. It is crucial to maintain vigilance, foster interdisciplinary collaboration, and respond promptly to ensure the safety and efficacy of LAAO procedures.
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Affiliation(s)
- Wei Ye
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Wei Zhou
- Department of Anesthesiology, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Weibing Zhao
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Jingjing Mao
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Wei Wang
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Liang Wei
- Cardiology Center, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Cardiology Center, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Linghui Zhao
- Cardiology Center, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Cardiology Center, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Yan Xu
- Department of Operating Room, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Operating Room, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Jing Yu
- Department of Operating Room, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Operating Room, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Zhi Fu
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Qiang Wang
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
- Yangzhou Institute of the Heart and Great Vessels, Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Zhuan Zhang
- Department of Anesthesiology, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
- Yangzhou Institute of the Heart and Great Vessels, Yangzhou University, Yangzhou, Jiangsu, 225012, China
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Lubis AC, Iqbal M, Munawar DA, Hartono B, Munawar M. A Simple Percutaneous Retrieval Technique for an Embolized Watchman Left Atrial Appendage Closure Device in the Thoracic Aorta Using a Homemade Snare. Int Heart J 2021; 62:1153-1155. [PMID: 34544965 DOI: 10.1536/ihj.20-790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 60-year old male with paroxysmal atrial fibrillation underwent a combined procedure of left atrial appendage occlusion and pulmonary vein isolation. However, an acute intraprocedural 24-mm Watchman device dislodgement occurred, and thus a decision for urgent surgery was made. However, it was noted during the surgery that the device had migrated further to the descending aorta, just distal to the left subclavian artery. Since a right sternotomy access for retrieval was not feasible, a percutaneous approach was justified. A homemade snare was created using a combination of a long sheath, J-wire, and a regular snare, and the device was successfully retrieved without significant difficulty.
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Affiliation(s)
| | | | - Dian Andina Munawar
- Binawaluya Cardiac Center.,Department of Cardiology and Vascular Medicine, Medical Faculty, Universitas Indonesia
| | | | - Muhammad Munawar
- Binawaluya Cardiac Center.,Department of Cardiology and Vascular Medicine, Medical Faculty, Universitas Indonesia
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Immohr MB, Sugimura Y, Lichtenberg A, Akhyari P. Atrial Thrombosis Caused by a Dislocated Left Atrial Appendage Closure Device After Mitral Valve Replacement. JACC Case Rep 2020; 2:2327-2330. [PMID: 34317165 PMCID: PMC8304549 DOI: 10.1016/j.jaccas.2020.05.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022]
Abstract
A patient with a left atrial appendage occlusion device underwent mitral valve replacement. Later, the patient developed a left atrial thrombosis with thromboembolic myocardial infarction caused by a dislocation of the occlusion device. Exclusion of the device and non-device-based appendage occlusion may have prevented the patient from experiencing postoperative complications (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Moritz B. Immohr
- Department of Cardiac Surgery, Medical School, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery, Medical School, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical School, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical School, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Ward AF, Lee R. Commentary: Watch out for WATCHMAN device failures. JTCVS Tech 2020; 4:165-166. [PMID: 34317998 PMCID: PMC8306117 DOI: 10.1016/j.xjtc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alison F Ward
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga
| | - Richard Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga
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Mansour MJ, Bénic C, Didier R, Noel A, Gilard M, Mansourati J. Late discovery of left atrial appendage occluder device embolization: a case report. BMC Cardiovasc Disord 2020; 20:305. [PMID: 32571300 PMCID: PMC7310060 DOI: 10.1186/s12872-020-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial appendage (LAA) closure has been well evaluated in the prevention of stroke in patients with atrial fibrillation. Device embolization remains one of the most common complications. To the best of our knowledge, there have been no reports of late discovery of LAA occluder device embolization at 1.5 years after implantation. CASE PRESENTATION We describe the case of a 77-year-old man who underwent uneventful LAA closure. Echocardiography performed the next day showed the device in place. The patient was discharged but was then lost to follow-up. 1.5 years later, he was admitted for ischemic stroke. Transesophageal echocardiography showed the absence of the occluder device in the LAA. Computed tomography scan of the abdomen showed the device in the abdominal aorta. Due to the high cardiovascular risk, the device was kept in place and the patient was treated medically. CONCLUSIONS Per-procedural and late device embolization are not uncommon. Review of the literature however showed no report of late discovery of device embolization at 1.5 years. Follow-up echocardiography is mandatory for the detection of endothelialization or embolization.
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Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.,Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Clément Bénic
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Antoine Noel
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France. .,Université de Bretagne Occidentale, Brest, France.
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Wang G, Kong B, Liu Y, Huang H. Percutaneous retrieval of a dislocated LAmbre left atrial appendage occluder in a canine model. J Cardiovasc Electrophysiol 2020; 31:529-535. [PMID: 31919914 DOI: 10.1111/jce.14344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/09/2019] [Accepted: 12/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dislocated left atrial appendage (LAA) occluders can be retrieved by percutaneous intervention when performing device embolization into the left atrium (LA), aorta (AO), or left ventricle (LV). However, few reports exist regarding LAmbre LAA occluder dislocation. OBJECTIVE The study was aimed to explore the outcome of retrieving dislocated LAmbre LAA occluder. METHODS Sixteen healthy dogs received LAmbre implants. After implantation of an occlusion device (not released), the occlusion device was completely retrieved. Subsequently, the device was released in the LA, resulting in the dislocation of the device. Angiography and transesophageal echocardiography (TEE) were performed to check the occluders position. Disposable grasping rat-tooth forceps were used to percutaneously retrieve the LAA occluder. RESULTS All the 16 dogs were successfully implanted with the LAmbre LAA occluder and the success rate was 100%. After the occluder was released, TEE and angiography confirmed that the device was located in the LA in eight cases (50%), in the AO in five cases (31%), and in the LV in three cases (19%). One subject died due to cardiogenic shock before the retrieval procedure was complete as the device fell into the LV. Two cases of device-related aortic valve injury occurred during the retrieval procedure when the device was located in the LV. No complications were observed when the device was located in the LA or AO. CONCLUSIONS Device retrieval is feasible in most cases. However, potentially lethal complications may occur once the device is dislocated into the LV/AO.
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Affiliation(s)
- Guangji Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Hubei, China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Hubei, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Hubei, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Hubei, China
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Perkins J, Bhagat R, Nichols M, Shah J. Reoccurrence of Stroke in a Patient With Peri-Device Leak of WATCHMAN Device. J Investig Med High Impact Case Rep 2020; 8:2324709620947622. [PMID: 32755246 PMCID: PMC7430078 DOI: 10.1177/2324709620947622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation is the leading cause of cardioembolic stroke, with emboli most commonly originating from the left atrial appendage. We report the case of a 71-year-old male with left atrial appendage closure via implantation of the WATCHMAN device, due to possible anticoagulation therapy failure and increased bleeding risk, following a stroke. Following a new stroke over a year later, a 1.8-mm peri-device leak was observed. Surgical records noted a minimal (<5 mm jet flow) peri-device leak after the installation, which was considered successful WATCHMAN implantation per protocol. This case highlights the persistent risk of cardioembolic stroke in patients with nonvalvular atrial fibrillation despite device implantation and questions the significance of peri-device leak and further management with anticoagulation for recurrent stroke.
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(Surgical remove of a dislocated Amplatzer septal occluder in the right pulmonary artery). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barth C, Behnes M, Borggrefe M, Akin I. Peri-interventional embolization of left atrial appendage occlusion devices: two manoeuvers of successful retrieval. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty001. [PMID: 31020083 PMCID: PMC6426106 DOI: 10.1093/ehjcr/yty001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Christian Barth
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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