Author + information
- Received March 18, 2017
- Revision received April 6, 2017
- Accepted April 13, 2017
- Published online August 2, 2017.
- Saroj Neupane, MD∗ (, )
- Zain Azzo, MD,
- Sushruth Edla, MD and
- Gerald I. Cohen, MD
- ↵∗Address for correspondence:
Dr. Saroj Neupane, Division of Cardiology, St John Hospital and Medical Center, 22101 Moross Road, VEP, 2nd floor Cath Lab, Detroit, Michigan 48236.
A 76-year-old woman with a medical history of permanent atrial fibrillation (CHA2DS2-VASc stage 4) underwent left atrium (LA) appendage closure with a LARIAT device (SentreHEART, Redwood City, California). She was then maintained on aspirin only due to major bleeding during postoperative period. Two years later, she presented with a mechanical fall. Chest computed tomography with contrast, done as work-up for trauma, showed a large unenhanced LA mass (Figure 1A). She underwent further evaluation with transesophageal echocardiogram (TEE), which showed very severe LA dilatation (LA volume = 150 ml or 79 ml/m2), LA appendage occlusion, and a new, very large, sessile mass attached to the posterior wall of the LA (Figures 1B, 1C, Online Video 1). The mass did not enhance after contrast infusion (Figure 1D, Online Video 2). This mass was new compared to her prior TEE during the procedure and the findings were consistent with thrombus. She was treated with vitamin K antagonist and had no clinical evidence of embolism as well as no change in the size or appearance of the mass on repeat TEE (Figure 1E) after 8 months. Previous reports on LARIAT device complications have described the infrequent occurrence of thrombus formation in close proximity of the occluded LA appendage, which has been attributed to local inflammation at the ligation site (1,2). The thrombus in our case was away from the ligation site indicating that LA appendage closure may not be sufficient in mitigating the risk of thromboembolism when significant LA stasis is present because of very severe LA dilatation.
For supplemental videos and their legends, please see the online version of this paper.
Dr. Cohen has served on the Speakers Bureau of Lantheus Medical Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 18, 2017.
- Revision received April 6, 2017.
- Accepted April 13, 2017.
- 2017 American College of Cardiology Foundation
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