Key result
LAAC leads to rare pulmonary vein perforation and systemic air embolism in undetected PV atresia.
Why the study?
Pulmonary vein perforation into the respiratory tract with systemic air embolism is an uncommon complication during left atrial appendage closure.
Case Report (n=1)
No
Anatomical variations of the pulmonary vein can lead to rare but severe complications like pulmonary vein perforation and systemic air embolism during LAAC, highlighting the potential value of preoperative CTA and intraoperative TEE.
BACKGROUND: Pulmonary vein perforation is an uncommon complication during cardiac intervention. We present a rare case of pulmonary vein perforation into the respiratory tract with systemic air embolism during left atrial appendage closure (LAAC). CASE PRESENTATION: -VASc score of 4, HAS-BLED score of 3, and prior ischaemic stroke). During the procedure, after delivering a super-stiff guidewire into the left superior pulmonary vein (LSPV), the patient suddenly developed a severe cough with haemoptysis upon advancement of a delivery sheath along the guidewire. Fluoroscopy showed signs of blood entering the left main bronchus, and fast transthoracic echocardiography revealed bubbles in the left heart without pericardial effusion. The procedure was terminated because of a major complication indicated by the repeated haemoptysis and headache, and haemostatic drugs were immediately administered. Subsequent chest computed tomography angiography (CTA) revealed a filling defect in the LSPV branches and bubbles in the aorta. The patient was transferred to the critical care unit for haemostasis and antibacterial treatment. Transthoracic echocardiography later that day showed no bubbles in the heart. The headache and haemoptysis significantly abated the following day. The bubbles in the aorta disappeared on chest CTA 7 days later. CONCLUSIONS: Interventional cardiologists should pay attention to anatomical variations of the pulmonary vein, which are associated with a high risk of complications of pulmonary vein perforation during LAAC. Preoperative CTA examination and intraoperative transoesophageal echocardiography might be helpful to avoid this complication.
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Qiao et al. (2023) conducted a case report in Persistent nonvalvular atrial fibrillation (n=1). Left atrial appendage closure (LAAC) was evaluated. Left atrial appendage closure was complicated by a rare pulmonary vein perforation into the respiratory tract with systemic air embolism in a 77-year-old man with undetected pulmonary vein atresia.
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