IMAGES IN CARDIOLOGY
Thrombus Formation After Successful Stapler Exclusion of the Left Atrial Appendage
Kathleen Stergiopoulos, MD, PhD*,
Frank Seifert, MD and
David L. Brown, MD*
* Department of Internal Medicine, Stony Brook University Medical Center, State University of New York Health Sciences Center, Stony Brook, New York
Department of Surgery, Stony Brook University Medical Center, State University of New York Health Sciences Center, Stony Brook, New York
Manuscript received September 29, 2008;
revised manuscript received October 10, 2008,
accepted November 3, 2008.
A 67-year-old man with atrial fibrillation presented with stroke 7 weeks after stapler exclusion of his left atrial appendage (LAA), surgical maze procedure, and bioprosthetic aortic valve replacement. Transesophageal echocardiogram (mid-esophageal view at 90°) noted an excluded LAA without persistent flow and a large mobile echodensity consistent with a thrombus attached to the level of the presumed staple line of the LAA, prolapsing through the mitral valve (Image, Online Video 1). The patient was fully anticoagulated with warfarin and in sinus rhythm. In a recent study, Kanderian et al. (1) described a high rate of unsuccessful surgical LAA closure. There is interest in surgical and percutaneous approaches for closure of the LAA to reduce the risk of stroke. Although surgeons might routinely exclude the LAA by some means, there is little outcome data with transesophageal echocardiography to justify its routine use. Future prospective studies will be necessary to determine which technique of LAA exclusion is best, if any, and if that procedure affords clinical benefit beyond that of warfarin alone.
 |
References
|
|---|
1. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure J Am Coll Cardiol 2008;52:924-929.[Abstract/Free Full Text]
|
Top
References