Massive hemoptysis after left atrial appendage occlusion in a patient with atrial fibrillation and left atrial appendage thrombus: a case report

Figures

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  Fig. 1. A-B Left atrial CTA shows LAA thrombus (A), enlarged at 1-year follow-up (B). C-F Transesophageal Echocardiography TEE (0°, 90°, 45° and 135° views) reveals a 15×12 mm thrombus near LAA ostium. CTA = CT angiography, LAA = Left atrial appendage, LAAT = Left atrial appendage thrombus

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  Fig. 2. A-E ICE-Guided LAAO Implantation. A-C Left Atrial Appendage sizing using the “orthogonal triaxial technique”, A-C shows the x, y, and z axes respectively, with the measured landing zone diameter ranging from 22 to 25 mm. D Transseptal puncture under direct ICE visualization. E Thrombus sealing and occluder deployment under ICE guidance. F-G LAAO implantation under DSA fluoroscopy. F The stiff guidewire was advanced into the left superior pulmonary vein through the Swartz sheath. The ICE catheter was advanced into the left atrium. G The ICE catheter was positioned at the mitral annulus region, with successful implantation of the left atrial appendage occluder. ICE = Intracardiac echocardiography, LAAO = Left atrial appendage occluder, DSA = Digital subtraction angiograph

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  Fig. 3. A-B Bronchial Artery CTA. Left lung hemorrhage, common trunk of left and right bronchial arteries with mild dilation. C Bronchial Artery Angiography Significant dilatation of the bilateral bronchial arteries. Micron gelatin sponge particles were injected for embolazation. D Chest CT Postoperative follow-up at two weeks showed significant hemorrhage absorption. CTA = CT angiography