Incomplete thoracoscopic left atrial appendage closure in a 79-year-old man resulted in a free-floating left atrial thrombus on postoperative day 5, necessitating emergency surgical removal.
Case Report (n=1)
Incomplete thoracoscopic closure of the left atrial appendage can lead to large free-floating thrombus formation, highlighting the potential need for concomitant tricuspid valve repair in patients with markedly impaired atrial hemodynamics to mitigate stasis.
A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced three cerebral infarctions and underwent thoracoscopic left atrial appendage closure (LAAC). Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at LAAC may help mitigate the risk of thrombus formation.
Nagatsuka et al. (Thu,) conducted a case report in Permanent atrial fibrillation and cardiomyopathy (n=1). Thoracoscopic left atrial appendage closure (LAAC) was evaluated on Free-floating thrombus in the left atrium. Incomplete thoracoscopic left atrial appendage closure in a 79-year-old man resulted in a free-floating left atrial thrombus on postoperative day 5, necessitating emergency surgical removal.