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Case Reports
. 2016 Mar;24(1):60-3.
doi: 10.4250/jcu.2016.24.1.60. Epub 2016 Mar 24.

Heart within a Heart

Tarun Jain  1 , Jainil Shah  1 , Sunay Shah  2 , Shalini Modi  2
Affiliations
Case Reports

Heart within a Heart

Tarun Jain et al. J Cardiovasc Ultrasound. 2016 Mar.

Abstract

Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation (AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device related thrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oral anti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure device for stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review of the various LAA closure devices, importance of periodic surveillance via echocardiography and management options to prevent this complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure device thrombus.

Keywords: Atrial fibrillation; Left atrial appendage; Transcatheter occlusion device.

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Figures

Fig. 1
Fig. 1. Zoom in of atrium from apical four chamber view. Unable to appreciate thrombus in this view without the use of contrast.
Fig. 2
Fig. 2. Heart within a heart. Three chamber view showing a stalk with pedunculated thrombus (arrow).
Fig. 3
Fig. 3. Contrast-enhanced echocardiogram enhances view of thrombus (arrow).
Fig. 4
Fig. 4. Transesophageal echocardiogram confirms a large bi-lobed thrombus (arrows).
Fig. 5
Fig. 5. Transesophageal 3D image shows thrombus attached to ventricular septal defect occluder device (arrow).
See this image and copyright information in PMC

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