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Saleeb AG, Farina JM, Jenkins A, Zeineddine R, Shawwaf K, Yang EH, Alsidawi S, Jaroszewski DE, Downey FX. Surgical Removal of a Migrated WATCHMAN Device. Methodist Debakey Cardiovasc J 2024; 20:80-86. [PMID: 39247626 PMCID: PMC11378705 DOI: 10.14797/mdcvj.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/15/2024] [Indexed: 09/10/2024] Open
Abstract
The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
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Yu K, Mei YH. Left atrial appendage occluder detachment treated with transthoracic ultrasound combined with digital subtraction angiography guided catcher: A case report. World J Clin Cases 2024; 12:1157-1162. [PMID: 38464917 PMCID: PMC10921316 DOI: 10.12998/wjcc.v12.i6.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/11/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND There are very few cases of cardiac occluder detachment, and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment. This case innovatively used ultrasound guidance combined with digital subtraction angiography (DSA) to completely remove the occluder, accumulating some experience. CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation. After the surgery, the occluder fell off and became free in the left ventricle, which is very dangerous. We innovatively used ultrasound guidance, combined with DSA, and interventional surgery to successfully capture the free occluder using a catcher, completely remove it, and then re implant a new left atrial appendage occluder. After the surgery, the patient recovered very well. CONCLUSION The size selection of the occluder is slightly conservative, and the shape of the left atrial appendage opening is irregular.
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Affiliation(s)
- Kai Yu
- Department of Ultrasound, Wuhan Dongxihu District People's Hospita, Wuhan 430400, Hubei Province, China
| | - Yun-Hua Mei
- Department of Infectious Diseases, Wuhan Dongxihu District People's Hospital, Wuhan 430400, Hubei Province, China
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Tschishow WN, Israel CW. [Dislodgement of a left atrial appendage occluder : Step-by-step management by retrograde extraction with a "home-made snare" and two sheaths]. Herzschrittmacherther Elektrophysiol 2020; 31:430-433. [PMID: 33034760 DOI: 10.1007/s00399-020-00726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dislodgement of a left atrial appendage occluder after liberation represents a nightmare in cardiac interventions. We present a case with this complication and an easy step-by-step protocol that can help to retrieve and venously extract this foreign body with less stress. Particularly the do-it-yourself construction of a "home-made snare" facilitates trapping of large implants which are too large for conventional snares.
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Affiliation(s)
- Wladimir N Tschishow
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
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Mansour MJ, Bénic C, Didier R, Noel A, Gilard M, Mansourati J. Late discovery of left atrial appendage occluder device embolization: a case report. BMC Cardiovasc Disord 2020; 20:305. [PMID: 32571300 PMCID: PMC7310060 DOI: 10.1186/s12872-020-01589-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial appendage (LAA) closure has been well evaluated in the prevention of stroke in patients with atrial fibrillation. Device embolization remains one of the most common complications. To the best of our knowledge, there have been no reports of late discovery of LAA occluder device embolization at 1.5 years after implantation. CASE PRESENTATION We describe the case of a 77-year-old man who underwent uneventful LAA closure. Echocardiography performed the next day showed the device in place. The patient was discharged but was then lost to follow-up. 1.5 years later, he was admitted for ischemic stroke. Transesophageal echocardiography showed the absence of the occluder device in the LAA. Computed tomography scan of the abdomen showed the device in the abdominal aorta. Due to the high cardiovascular risk, the device was kept in place and the patient was treated medically. CONCLUSIONS Per-procedural and late device embolization are not uncommon. Review of the literature however showed no report of late discovery of device embolization at 1.5 years. Follow-up echocardiography is mandatory for the detection of endothelialization or embolization.
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Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.,Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Clément Bénic
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Antoine Noel
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France.,Université de Bretagne Occidentale, Brest, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, Brest, Cedex, 29609, France. .,Université de Bretagne Occidentale, Brest, France.
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Device Embolization in Structural Heart Interventions. JACC Cardiovasc Interv 2019; 12:113-126. [DOI: 10.1016/j.jcin.2018.08.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/31/2022]
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Fastner C, Hoffmann L, Aboukoura M, Behnes M, Lang S, Borggrefe M, Akin I, Nienaber CA. Real-world experience comparing two common left atrial appendage closure devices. BMC Cardiovasc Disord 2018; 18:171. [PMID: 30126370 PMCID: PMC6102880 DOI: 10.1186/s12872-018-0899-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background The interventional left atrial appendage closure (LAAC) is a guideline-conform alternative to oral anticoagulation (OAC) in non-valvular atrial fibrillation patients with OAC ineligibility. It was aimed to directly compare two contemporary devices in a real-world patient population. Methods LAAC was conducted in two centres between 2010 and 2014 as well as between 2014 and 2017, respectively, in a standard fashion based on the specific manufacturer’s recommendations. Baseline characteristics, procedural data and event rates during intra-hospital and 6 months follow-up were registered in a retrospective approach, and analysed in device-related groups. Results A total of 189 patients presented for LAAC device implantation. Baseline characteristics were mostly evenly distributed. In 148 patients, a Watchman™ device (Boston Scientific, Natick, MA, USA) was successfully implanted, an Amplatzer™ Amulet™ (St. Jude Medical, St. Paul, MN, USA) in 34 patients (96.1 and 97.1%, respectively; p = 1.00). Major access site bleedings were more frequent in the Amplatzer™ Amulet™ group (8.9 versus 1.4%; p = 0.046). No intra-hospital thromboembolic event was present. During 6 months follow-up, peri-device leaks > 5 mm and thromboembolic events were uncommon (each p = n.s.). Conclusions While procedural success was equally high with both contemporary devices, complications during follow-up were rare, and evenly distributed.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), and DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Lea Hoffmann
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Mohamed Aboukoura
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), and DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), and DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), and DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), and DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph A Nienaber
- Royal Brompton Hospital, London, United Kingdom and National Heart and Lung Institute, Imperial College London, London, UK
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Fastner C, Behnes M, Ansari U, El-Battrawy I, Borggrefe M. Interventional Left Atrial Appendage Closure: Focus on Practical Implications. Interv Cardiol 2017. [DOI: 10.5772/67773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Fastner C, Behnes M, Sartorius B, Wenke A, El-Battrawy I, Ansari U, Gill IS, Borggrefe M, Akin I. Procedural success and intra-hospital outcome related to left atrial appendage morphology in patients that receive an interventional left atrial appendage closure. Clin Cardiol 2017; 40:566-574. [PMID: 28409845 DOI: 10.1002/clc.22699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The interventional left atrial appendage (LAA) closure represents an emerging alternative to oral anticoagulation for stroke prevention in certain atrial fibrillation patients. Preliminary results have suggested high procedural success rates and fewer peri-interventional complications; however, there persists an insufficient understanding of the role of many underlying confounding variables (e.g., anatomical characteristics). HYPOTHESIS It was investigated whether varying LAA morphologies influence procedural success as well as in-hospital outcome. METHODS Sixty-seven patients ineligible for long-term oral anticoagulation were included in this single-center, prospective, observational registry spanning from the years 2014 to 2016. Interventions were performed with the Watchman occluder (Boston Scientific, Natick, MA) or the Amplatzer Amulet (St. Jude Medical, St. Paul, MN), at the operator's discretion. Results derived from the data describing procedural success, fluoroscopy, and peri-interventional safety events were classified according to the presenting LAA morphology (cauliflower, cactus, windsock, and chicken wing). RESULTS Rates of successful implantation were high across all groups (≥98%; P = 0.326). Surrogate parameters underlining procedural complexity like median total duration (P = 0.415), median fluoroscopy time (P = 0.459), median dose area product (P = 0.698), and the median amount of contrast agent (P = 0.076) demonstrated similar results across all groups. Likewise, the periprocedural complication rate was not significantly different and was mainly restricted to minor bleeding events. CONCLUSIONS Irrespective of the varying morphological presentation of the LAA, the procedural success rates, interventional characteristics, and safety events did not significantly differ among patients receiving an interventional LAA closure.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Sartorius
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Annika Wenke
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ishar-Singh Gill
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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