Key result
Left atrial appendage occlusion complicated by an iatrogenic interatrial septal defect led to multiple systemic paradoxical emboli, including stroke, from a deep vein thrombosis.
Case Report (n=1)
This case demonstrates that an iatrogenic interatrial septal defect created during LAAO can serve as a conduit for paradoxical embolization if a venous thromboembolism occurs.
May permit paradoxical embolization from DVT via iatrogenic ASD after LAAO; hypothesis-generating and should not yet change practice.
A 75-year-old woman with a history of intracranial haemorrhage, atrial fibrillation and coronary artery bypass graft underwent elective left atrial appendage occlusion (LAAO) for stroke prevention. The procedure was successful, however on the third postoperative day, she presented with a lymph leak at the right femoral venous access site. She was admitted for conservative management of the lymph leak with immobility and intravenous fluids. Her inpatient stay was complicated by a right lower limb deep vein thrombosis (DVT), left middle cerebral artery territory ischaemic stroke, pulmonary emboli (PEs) and a splenic infarction. The mechanism of the systemic emboli was that of paradoxical emboli from the DVT passing through an interatrial septal defect created as part of the LAAO procedure, a previously unreported complication of LAAO. She was managed with 6 months of low-dose oral anticoagulation for treatment of DVT and PE and has made a full neurological recovery.
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Millar et al. (2021) conducted a case report in Atrial fibrillation (n=1). Left atrial appendage occlusion was evaluated. Left atrial appendage occlusion complicated by an iatrogenic interatrial septal defect led to multiple systemic paradoxical emboli, including stroke, from a deep vein thrombosis.
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