Author + information
- Received December 6, 2017
- Accepted December 18, 2017
- Published online May 21, 2018.
- Jian Liu, MBBSa,
- Fang-Zhou Liu, MD, PhDb,
- Xian-Hong Fang, MD, PhDb,
- Hong-Tao Liao, MD, PhDb,
- Hui-Ming Guo, MD, PhDa,∗ ( and )
- Shu-Lin Wu, MD, PhDb
- aDepartment of Cardiac Surgery, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- bDepartment of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- ↵∗Address for correspondence:
Dr. Hui-Ming Guo, Department of Cardiac Surgery, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 96 Dongchuan Road, Guangzhou, Guangdong 510080, China.
During the left atrial appendage (LAA) occlusion procedure for secondary prevention, a 24-mm WATCHMAN device (Boston Scientific, Natick, Massachusetts) was chosen to occlude the LAA after fluoroscopic angiography and transesophageal echocardiography examination. However, a sudden forward movement during the device deployment and LAA angiography indicated that the WATCHMAN was located at the pericardium with contrast leakage (Figure 1A, Online Video 1). A sustained tug was performed immediately to compress the LAA and hemorrhagic area to avoid unlimited pericardial bleeding and keep the hemodynamic stable (Figure 1B).
After considering these conditions, the cardiac surgery team decided to perform device removal and LAA resection under video-assisted thoracoscopy. After the pericardium was opened, an unfolded WATCHMAN device was found on the LAA surface without significant bleeding (Figure 1C, Online Video 2). The WATCHMAN device was slightly constricted by using the suture line to fasten the ambilateral fixation anchors, and subsequently the LAA was clamped by an endoscopic linear stapler (Echelonflex, Ethicon, California) (Figure 1D, Online Video 3). Successively and almost simultaneously, the device was released, and the LAA was excluded without further bleeding (Figure 1E).
LAA occlusion device-related cardiac perforation is rare and serious; however, pericardium deployment and a sustained tug may help avoid continuous bleeding and acquire sufficient preparation time for video-assisted thoracoscopic surgery avoid open-chest surgery.
Dr. Wu received study support from the National Nature Science Foundation of China (no. 81370295); Science and Technology Program of Guangdong, China (no. 201508020261); and the Science and Technology Planning of Guangzhou, China (no. 2014B070705005). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 6, 2017.
- Accepted December 18, 2017.
- 2018 American College of Cardiology Foundation