Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

Abstract

A patient underwent left atrial appendage occlusion due to recurrent stroke despite new oral anticoagulant therapy. The patient later presented with severe acute mitral regurgitation secondary to occluder device migration, which was retrieved percutaneously from the descending aorta via the femoral artery. Mitral surgical repair was required and successfully performed. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; LAAO, left atrial appendage occlusion; OAC, oral anticoagulant; TOE, transesophageal echocardiography; acute heart failure; atrial fibrillation; mitral valve; stroke.

Graphical abstract

Figure 1

Pre- and Post-Procedural Imaging (A) Amplatzer Amulet implanted in the left atrial appendage under fluoroscopic control. (B) Peri-procedural transesophageal echocardiography showing mitral valve with normal leaflet coaptation. 2-dimensional transesophageal echocardiography 2 weeks after the procedure showing occluder device absence (C) and a new-onset mitral prolapse of the posterior leaflet (yellow arrow) due to primary tendinous chordae rupture (D).

Figure 2

Severe Acute Mitral Regurgitation (A) Pulsed wave Doppler pulmonary veins showing systolic pulmonary flow reversal. (B and D) Color Doppler transesophageal echocardiography revealed severe eccentric mitral regurgitation. (C) 2-dimensional transesophageal echocardiography showing posterior flail leaflet (yellow arrow) with an eccentric jet directed to the interatrial septum.

Figure 3

Device Retrieval Under Fluoroscopic Control Goose-neck snare (A), endomyocardial biopsy forceps (yellow arrows) (B and C), and myotomy forceps (red arrow) (D) used for device retrieval through right femoral artery.