A single Watchman FLX Pro device successfully achieved both left atrial appendage occlusion and sealing of a lateral mitral paravalvular leak, with durable closure at 3 months.
Case Report (n=1)
Can a single left atrial appendage occlusion device simultaneously close the left atrial appendage and a lateral mitral paravalvular leak in a high-risk patient with atrial fibrillation?
A single left atrial appendage occlusion device can be used to simultaneously seal a lateral mitral paravalvular leak and occlude the left atrial appendage in high-risk patients.
BACKGROUND: An 81-year-old man with 2 prior mitral valve replacements developed recurrent symptomatic paravalvular leak (PVL) despite prior transcatheter closure with vascular plugs. He had ongoing heart failure hospitalizations and hemolytic anemia that limited uninterrupted anticoagulation in the setting of atrial fibrillation and high thromboembolic risk. CASE SUMMARY: The patient underwent a combined procedure with redo PVL closure and left atrial appendage occlusion. Given close anatomic proximity of the lateral PVL to the appendage ostium, a Watchman FLX Pro device was deployed to achieve both left atrial appendage occlusion and sealing of the lateral PVL. Postprocedure, mitral PVL resolved, hemolysis improved at 1-month follow-up, and PVL closure was durable on 3-month follow-up transesophageal echocardiography. DISCUSSION: To our knowledge, this is the first report of Watchman device use for mitral PVL closure. In high-surgical risk patients with atrial fibrillation and bleeding limitations, this single-device strategy may simplify treatment and reduce the need for additional interventions.
Kay et al. (Sat,) conducted a case report in Mitral paravalvular leak and atrial fibrillation (n=1). Watchman FLX Pro device was evaluated on Mitral PVL resolution and hemolysis improvement. A single Watchman FLX Pro device successfully achieved both left atrial appendage occlusion and sealing of a lateral mitral paravalvular leak, with durable closure at 3 months.
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