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Mosalpuria Y, Ibrahim M, Fayed M, Guruswamy J, DePorre AR. Massive Hemoptysis: An Unusual Complication of Left Atrial Appendage Occlusion Device in Two Patients. Cureus 2024; 16:e61451. [PMID: 38947731 PMCID: PMC11214821 DOI: 10.7759/cureus.61451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Left atrial appendage occlusion (LAAO) devices have emerged as a promising alternative for stroke prevention in non-valvular atrial fibrillation (NVAF) patients with contraindications to chronic anticoagulation therapy. The most common life-threatening procedural complications described in the literature include pericardial effusion, air embolism, and stroke. We here present a case report of two patients who experienced identical but rare post-procedural complications of pulmonary venous bleed, presenting as hemoptysis.
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Affiliation(s)
- Yogita Mosalpuria
- Anesthesiology, Pain Management and Perioperative Medicine, Mount Sinai Hospital, New York, USA
| | | | - Mohamed Fayed
- Anesthesiology, Montefiore Medical Center, Wakefield Campus, New York, USA
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Wang Y, Song B, Liu B, Zhang H, Bi C, Liu W, Ma G, Li B. Case report: pulmonary artery perforation during transseptal puncture for left atrial appendage closure requires emergency cardiac operation. Front Cardiovasc Med 2023; 10:1218582. [PMID: 37881723 PMCID: PMC10597659 DOI: 10.3389/fcvm.2023.1218582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Patients with atrial fibrillation who take a high bleeding risk and are not candidates for oral anticoagulation therapy are increasingly being referred for left atrial appendage closure (LAAC) as an alternative method of stroke prevention. However, certain manipulations performed during the LAAC procedure, such as transseptal puncture (TSP), may potentially result in vessel injury and lead to cardiac tamponade or even fatality. Clinical significance and management strategies associated with these complications remain controversial. A 74-year-old female patient with atrial fibrillation was referred for left atrial appendage occlusion. During the puncture of the atrial septum, the catheter sheath inadvertently exited through the roof of the right atrium and continued to advance, resulting in pulmonary artery perforation. The patient underwent immediate pericardiocentesis and drainage, followed by surgical exploration for suturing the tear in the pulmonary artery and ligation of the left atrial appendage. This represents the first reported case of a pulmonary artery perforation occurring during a transseptal puncture procedure for left atrial appendage closure. The case exemplifies the feasibility of emergency cardiac surgery as a therapeutic intervention.
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Affiliation(s)
- Yue Wang
- Department of Clinical Medicine, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Beibei Song
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Bing Liu
- Department of Cardiovascular Surgery, Zibo Central Hospital, Zibo, China
| | - Hui Zhang
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Chenglong Bi
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Wenhao Liu
- Department of Cardiology, Zibo Central Hospital, Zibo, China
- Zibo Central Hospital, Binzhou Medical University, Zibo, China
| | - Gang Ma
- Department of Cardiovascular Surgery, Zibo Central Hospital, Zibo, China
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, Zibo, China
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Alkhouli M, Di Biase L, Natale A, Rihal CS, Holmes DR, Asirvatham S, Bartus K, Lakkireddy D, Friedman PA. Nonthrombogenic Roles of the Left Atrial Appendage: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:1063-1075. [PMID: 36922093 DOI: 10.1016/j.jacc.2023.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
The atrial appendage (LAA) is a well-established source of cardioembolism in patients with atrial fibrillation. Therefore, research involving the LAA has largely focused on its thrombogenic attribute and the utility of its exclusion in stroke prevention. However, recent studies have highlighted several novel functions of the LAA that may have important therapeutic implications. In this paper, we provide a concise overview of the LAA anatomy and summarize the emerging data on its nonthrombogenic roles.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- St David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Charanjit S Rihal
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Samuel Asirvatham
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Medical College, John Paul Hospital, Jagiellonian University, Krakow, Poland
| | | | - Paul A Friedman
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Bretones-Pino T, Rivera-López R, Carrero-Castaño A, Molina-Navarro E. Pulmonary Artery Perforation by Atrial Appendage Closure Device and the Contribution of Auricular Contraction to Its Pathogenesis. CJC Open 2022; 4:97-99. [PMID: 35072032 PMCID: PMC8767028 DOI: 10.1016/j.cjco.2021.07.021] [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: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Teresa Bretones-Pino
- Department of Interventional Cardiology, Virgen de las Nieves University Hospital, Granada, Spain
- Corresponding author: Dr Teresa Bretones-Pino, Department of Interventional Cardiology, Virgen de las Nieves University Hospital, Av. de las Fuerzas Armadas, 2, Granada 18014, Spain. Tel.: +34 645216986.
| | - Ricardo Rivera-López
- Department of Interventional Cardiology, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Eduardo Molina-Navarro
- Department of Interventional Cardiology, Virgen de las Nieves University Hospital, Granada, Spain
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Govea N, Chan J. Airway Hemorrhage During Left Atrial Appendage Exclusion Device Insertion. J Cardiothorac Vasc Anesth 2021; 36:3124-3128. [PMID: 34876351 DOI: 10.1053/j.jvca.2021.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nicolas Govea
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
| | - June Chan
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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Pracoń R, De Backer O, Konka M, Kępka C, Kruk M, Trochimiuk P, Dębski M, Dzielińska Z, Søndergaard L, Demkow M. Imaging risk features for device related pulmonary artery injury after left atrial appendage closure with Amplatzer™ Amulet™ device. Catheter Cardiovasc Interv 2020; 98:E420-E426. [PMID: 33220011 DOI: 10.1002/ccd.29393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/23/2020] [Accepted: 11/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to find imaging risk features for device related-pulmonary artery (PA) injury (DR-PAI) in patients after left atrial appendage closure (LAAC). BACKGROUND Cardiac tamponade resulting from DR-PAI is a rare but life-threatening complication of LAAC. METHODS In vitro analysis of Amplatzer™ Amulet™ (Abbott, MN) device was done. Measurements of the distance between PA and Amplatzer lobe at its middle part, distal part, and along the stabilizing wires' trajectory (wires-to-PA distance) were taken in 100 consecutive patients on post-LAAC computed tomography (CT) studies. Clinical outcomes were collected. RESULTS In vitro analysis indicated that both middle and distal lobe had to be in close PA proximity (<1.5 mm) for the stabilizing wires to cause risk for DR-PAI, configuration called ''cuddling lobe orientation''. On CT measurements middle lobe-PA distance was 4.7 mm (IQR = 2.7-9.5), with close proximity in 4 (4%) patients, and distal lobe-PA distance was 3.2 mm (IQR = 1.8-7.2 mm), with close proximity in 17 (17%) patients. Stabilizing wires were pointing toward PA in 47 patients (47%) with median wire-to-PA distance 5.7 mm (IQR = 3.6-8.5 mm). ''Cuddling'' was found in 2 (2%) patients and resulted in shorter wires-to-PA distance vs no ''cuddling'' group (2.3 vs 5.8 mm p <.01). At 2.9 ± 1.0 yrs of follow-up, the two patients with ''cuddling lobe orientation'' on post-LAAC CT scan developed late cardiac tamponades (p <.001). One of those required surgery, which confirmed DR-PAI. CONCLUSIONS ''Cuddling lobe orientation'' of Amulet device with the PA was associated with short wires-to-PA distance and late pericardial effusions, including DR-PAI. Hence, such device-to-PA configuration should be avoided.
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Affiliation(s)
- Radosław Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marek Konka
- Congenital Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Cezary Kępka
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Trochimiuk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Dębski
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Zofia Dzielińska
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Lars Søndergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
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