Vol 29, No 5 (2022)
Image in Cardiovascular Medicine
Published online: 2022-09-29

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Percutaneous left atrial appendage closure containing thrombus

Mohsen Mohandes1, Cristina Moreno1, Marta Guillén2, Leydimar Anmad Shihadeh2, Diego Zambrano1
Pubmed: 36196661
Cardiol J 2022;29(5):884-885.

Abstract

Not available

clinicAL CARDIOLOGY

IMAGE IN CARDIOVASCULAR MEDICINE

Cardiology Journal

2022, Vol. 29, No. 5, 884–885

DOI: 10.5603/CJ.2022.0086

Copyright © 2022 Via Medica

ISSN 1897–5593

eISSN 1898018X

Percutaneous left atrial appendage closure containing thrombus

Mohsen Mohandes1Cristina Moreno1Marta Guillén2Leydimar Anmad Shihadeh2Diego Zambrano1
1Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
2Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Tarragona, Spain
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Address for correspondence: Mohsen Mohandes, MD, PhD, Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Tarragona, Spain, tel: 0034-977295817, e-mail: mohandesmohsen@hotmail.com

Received: 23.05.2021 Accepted: 8.06.2022

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

An 85-year-old man with permanent atrial fibrillation was referred to our institution for percutaneous left atrial appendage (LAA) closure (LAAC). The patient had chronic renal disease (CRD) with glomerular filtration rate (GFR) 25 mL/min and under acenocumarol therapy had developed melaena due to colonic angiodysplasia with severe anemia (hemoglobin: 5.9 g/dL). Transesophageal echocardiography (TEE) revealed thrombus within LAA (Fig. 1A). LAAC using simultaneous cerebral protection with SentinelTM (Claret Medical, Santa Rosa, CA, USA) was scheduled. The procedure was performed under general anesthesia and guided by TEE. After transseptal puncture, heparin was administered and afterward SentinelTM was inserted through right radial artery (Fig. 1B). A LAmbreTM (Lifetech Scientific Corp., Shenzhen, China) 24/30 mm for LAAC was chosen and contrast medium injection was avoided during the procedure. A partial umbrella delivery of LAmbre was carried out in front of the LAA and the whole system was advanced slowly within LAA trying not to touch the thrombus (Fig. 1C). Initially, the umbrella position seemed to be a little deep so the umbrella was partially recaptured and delivered again in a better position. Afterward, the cover part of the device was delivered and pulled back slightly so to achieve a proper positioning. TEE confirmed an adequate position and absence of any leakage while tug test manoeuver revealed the device’s stability. Hence, the LAmbre was ultimately released without incidence (Fig. 1D, Suppl. Video 1). SentinelTM was retrieved and no debris was identified in the system. The patient post-intervention course was uneventful.

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Figure 1. A. Left atrial appendage shows thrombus at its bottom; B. Sentinel with its two baskets is inserted into the right brachiocephalic trunk and left carotid artery; C. Partial delivery of umbrella in the left atrial appendage; D. Complete release of the device, showing umbrella and cover part in a good position.
Conflict of interest: None declared