Case Report
An 80-year-old male patient was admitted 2 days after sudden syncope.
The duration of atrial
fibrillation is unknown (CHA2DS2-VASc:6 points, HAS-BLED: 4 points) and
continues to
receive oral anticoagulant therapy with rivaroxaban. Previous history of
gastric bleeding,Have a
long history of drinking alcohol. The patient refuse to continue
long-term oral anticoagulants. After
Admission, esophageal echocardiography ruled out intraluminal
thrombus.Dynamic electrocardiogram:The average heart rate is 66bpm,the
slowest heart rate is 30bpm,The fastest heart rate is 139bpm,A total of
92033 cardiac beats were analyzed, Long RR intervals greater than 2000
ms were 67,and the longest is 2562 ms.Total atrial fibrillation, 124
ventricular premature beats, Cardiac ultrasound showed widening of the
ascending aorta (3.5cm),enlargement of the left atrium (4.4cm),
enlargement of the right atrium (5.4cm), and enlargement of the right
ventricle (4.3cm). LVEF: 58%. Widening of ascending aorta, degenerative
degeneration of aortic valve, enlargement of atriums, mild mitral
regurgitation, moderate tricuspid regurgitation, and arrhythmia.
Diagnosis:(1).Persistent atrial fibrillation,(2). Transient ischemic
attack,(3).coronary atherosclerosis, myocardial bridging,(4). Grade 1
hypertension (highrisk group). The patient underwent LAAO surgery, and
there were no significant abnormalities after the surgery. On the first
day after surgery, cardiac ultrasound revealed abnormal echogenicity in
the left ventricular cavity, which is considered occluder
displacement(Figure 1). Perform left atrial appendage occluder removal
and LAAO on the same day. Puncture through the right femoral vein,
insert a blood vessel sheath,send a long sheath tube, atrial septal
puncture needle to the superior vena cava, and retract to the atrial
septum, after successful RAO45 ° atrial septal puncture, Medtronic 4FC12
adjustable bending sheath was inserted, insert the 7F AL1 catheter along
the flexible sheath to the left ventricle and perform occluder grasping
(Figure 2), after successfully grasping the occluder, push and inject
ice salt water along the sheath to soften the occluder. after fully
softening the occluder, smoothly grasp the occluder into the adjustable
bending sheath and successfully remove the occlude. The patient’s vital
signs are stable and there are no special discomfort, continue with LAAO
surgery. Send the pigtail catheter along the outer sheath to left atrial
appendage angiography for examination, and measure the inner diameter
and opening diameter of the left atrial appendage, Extracorporeal
configuration of LACbes26mm according to the patient’s left atrial
appendage size 32mm left atrial appendage occlusion umbrella. Release of
occlusive umbrella under RAO30+CAU20 imaging, Under X-ray, the occlusive
umbrella is stable at the opening of the left atrial appendage, and
angiography shows isolation of blood flow between the left atrial
appendage and the left atrium.perform another traction test for 1
minute, RAO30+CAU20 confirmed that the sealing umbrella was firmly
fixed, and there was no obvious leakage of contrast agent around the
umbrella, indicating satisfactory sealing, Cardiac ultrasound
examination showed that the occlusive umbrella was stably fixed at the
opening of the left atrial appendage, and there was no signal from the
left atrial appendage or left atrial septum around the umbrella,
indicating a successful closure of the left atrial appendage.
Figure 1 Cardiac
ultrasound indicates occlusion device displacement