ABSTRACT
Background:
Incomplete surgical left
atrial appendage (LAA) closure, in the form of incompletely surgically ligated LAA (ISLL), increases thrombo-embolic
risk in
patients with
atrial fibrillation (AF). Although its management is not standardized, the percutaneous closure of ISLL could be an alternative in
patients with
contraindication for
anticoagulants. We present the case of a percutaneous transcatheter LAA
device implantation in a
patient with AF and ISLL, complicated by severe anaemia. Case
summary:
A 83-year-old
woman, with permanent AF and a
history of previous surgical LAA
ligation, was referred to our
hospital for
fatigue and worsening dyspnoea.
Laboratory tests showed severe microcytic anaemia, with a haemoglobin level of 4.9â
g/dL (normal reference 13.8-18.0â
g/dL). Oesophagogastroduodenoscopy and
colonoscopy excluded signs of either recent or ongoing haemorrhage. After achieving clinical improvement by haemotransfusions, we performed a transoesophageal
echocardiography that showed an ISLL with a narrow
neck of 5â
mm. Since the
patient had high thrombo-embolic and haemorrhagic
risk (CHA2DS2-VASc
risk score of 4 and a HAS-BLED score of 4), we decided to discontinue
anticoagulant therapy and perform elective percutaneous transcatheter LAA occlusion (LAAO) with an Amplatzer Amulet
device.
Patient was discharged in good clinical status. After three months, the stability of haemoglobin level and the absence of
device thrombosis allowed the discontinuation of antithrombotic
therapy.
Discussion:
We described the first experience of percutaneous ISLL closure with Amulet
device (Abbott Vascular, Santa Clara, CA, USA), a commercially available
device for LAAO. The
procedure was feasible and safe, without long-term
complications.
