Key result
Thoracoscopic left atrial appendectomy was successfully performed as secondary prevention in a patient with cardiogenic embolism despite appropriate warfarin therapy, with no recurrence at 1 year.
Case Report (n=1)
No
Thoracoscopic left atrial appendectomy may serve as an effective secondary prevention strategy for patients experiencing cardiogenic embolism despite appropriate therapeutic anticoagulation.
Thoracoscopic appendectomy appears feasible for refractory embolism on warfarin; leaves open efficacy versus medical therapy in larger cohorts.
A 74-year-old man with a past medical history of bradycardiac atrial fibrillation and an old cerebral infarction presented with dysarthria. He had been treated with warfarin and PT-INR on admission was 2.0. MRI of the head revealed an acute ischemic stroke involving the cerebellum and left occipital lobe. Because transesophageal cardiac echography showed a thrombus in the left atrial appendage, anticoagulant treatment with warfarin and heparin was initiated. The thrombus was enlarging; therefore, we changed the anticoagulant therapy to apixaban with heparin on day 11. On day 17, a hemorrhagic cerebral infarction occurred. After the hemorrhage diminished, we treated him with warfarin aiming for a PT-INR between 3 and 4. The thrombus gradually shrank and disappeared on day 110. Finally, a thoracoscopic left atrial appendectomy was performed as a secondary prevention, with no recurrence till date.
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Kikuno et al. (2017) conducted a case report in Cardiogenic embolism, nonvalvular atrial fibrillation (n=1). Thoracoscopic left atrial appendectomy was evaluated on Recurrence of stroke. Thoracoscopic left atrial appendectomy was successfully performed as secondary prevention in a patient with cardiogenic embolism despite appropriate warfarin therapy, with no recurrence at 1 year.
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