Large Free-Floating Left Atrial Thrombus After Incomplete Thoracoscopic Closure of the Left Atrial Appendage.
Motoki Nagatsuka, Tohru Asai, Kenichiro Noguchi et al.
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Case in brief
A 79-year-old man with permanent atrial fibrillation and cardiomyopathy, previously treated with an implantable cardioverter-defibrillator, had sustained three cerebral infarctions despite anticoagulation. After thoracoscopic left atrial appendage closure, transthoracic echocardiography on postoperative day 5 showed a free-floating left atrial thrombus. Emergency surgery removed the thrombus and included tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall; severe tricuspid regurgitation may also have contributed to atrial stasis.
What made this case unusual
A large, free-floating left atrial thrombus was detected soon after thoracoscopic appendage closure, with incomplete appendage exclusion identified as a key procedural pitfall.
Diagnostic / clinical pearl
After left atrial appendage closure, echocardiography can identify thrombus associated with incomplete appendage exclusion; severe tricuspid regurgitation may also contribute to atrial stasis.
Why it matters
The authors suggest that concomitant tricuspid valve repair at appendage closure may help mitigate thrombus risk in patients with markedly impaired atrial hemodynamics.