Percutaneous Retrieval of Embolized Left Atrial Appendage Occlusion Device From Mitral Valve Apparatus

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial fibrillation and Left Atrial Appendage Occlusion device embolization (n=1). Intervention: Percutaneous retrieval of embolized LAAO device using endovascular snares. Primary outcome: Successful device retrieval and clinical recovery.

Q: What does this research mean for the field?

Percutaneous retrieval of an embolized left atrial appendage occlusion device from the mitral valve apparatus using two snare wires is feasible and achieves successful clinical recovery. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muslim Madhag; Bruno Chan Chin; Samer Arnous; Cormac O’Connor; Thomas Kiernan

doi:10.1016/j.jaccas.2026.108800

June 1, 2026JACC Case ReportsOpen Access

Percutaneous Retrieval of Embolized Left Atrial Appendage Occlusion Device From Mitral Valve Apparatus

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Key result

Dual-snare percutaneous retrieval successfully recovers an embolized LAAO device from the mitral apparatus.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Although left atrial appendage occlusion is generally safe and effective, complications such as device displacement into the mitral apparatus can occur.

Key Points

To describe the urgent diagnosis, parallel stabilization, and minimally invasive catheter retrieval of an embolized left atrial appendage occlusion device obstructing the mitral valve apparatus.
Diagnosed device migration and total mitral valve apparatus obstruction using bedside transthoracic echocardiography.
Managed the patient with fluid resuscitation, intravenous heparin, adrenaline, synchronized direct current cardioversion, coronary angiography, and transcatheter snare retrieval.
Synchronized direct current cardioversion restored sinus rhythm, raised systolic blood pressure from 48 mm Hg to 167 mm Hg, and facilitated partial device migration back into the left atrium.
Percutaneous retrieval successfully extracted the displaced device using 2 snare wires without requiring open-heart surgery.
Postprocedural echocardiography verified an intact mitral valve without pericardial effusion, and the patient maintained an uneventful recovery at 4-week follow-up.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A frail 84-year-old man with atrial fibrillation and intolerance to oral anticoagulants who experienced early device displacement into the mitral apparatus following LAAO implantation, with 4 weeks of follow-up.

I

Intervention

Percutaneous retrieval of an embolized 34-mm Amplatzer Amulet left atrial appendage occlusion device using 2 endovascular snare wires, following initial stabilization with direct current cardioversion and plain old balloon angioplasty.

Implication

Early LAAO device displacement can cause severe complications like cardiogenic shock and myocardial infarction, but can be managed safely through a staged approach including percutaneous device retrieval without necessitating surgery.

Abstract

BACKGROUND: Left atrial appendage occlusion (LAAO) is a safe and effective intervention for patients with atrial fibrillation who are unable to tolerate anticoagulation. Despite the safety of the procedure, complications including device displacement are a potential risk. CASE SUMMARY: A frail 84-year-old man underwent LAAO implantation, which was complicated by an early device displacement into the mitral apparatus, precipitating myocardial infarction and cardiogenic shock. The device was retrieved percutaneously with 2 snare wires, with a good patient recovery on follow-up. DISCUSSION: Device displacement to the mitral apparatus is a rare complication with high mortality. Transcatheter device retrieval is feasible with the right skills and equipment with good final results. TAKE-HOME MESSAGES: Early dislodgement of LAAO devices, though rare, can cause acute mitral valve obstruction and cardiogenic shock. Mechanical obstruction and ischemic events may coexist, necessitating rapid multimodality imaging and parallel management strategies.

Discussion

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Cite This Study

Madhag et al. (2026) conducted a case report in Atrial fibrillation and Left Atrial Appendage Occlusion device embolization (n=1). Percutaneous retrieval of embolized LAAO device using endovascular snares was evaluated on Successful device retrieval and clinical recovery. Transcatheter percutaneous retrieval of an embolized left atrial appendage occlusion device from the mitral apparatus using two endovascular snares was successful and resulted in full clinical recovery.

synapsesocial.com/papers/6a31570faf7cf7f8256b3d03 https://doi.org/10.1016/j.jaccas.2026.108800

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Percutaneous Retrieval of Embolized Left Atrial Appendage Occlusion Device From Mitral Valve Apparatus

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Percutaneous Retrieval of Embolized Left Atrial Appendage Occlusion Device From Mitral Valve Apparatus

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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