Author + information
- Received March 23, 2016
- Accepted April 7, 2016
- Published online July 11, 2016.
- Ignacio Cruz-González, MD, PhD,
- Juan C. Rama-Merchan, MD, PhD∗ (, )
- Javier Rodríguez-Collado, MD,
- Javier Martín-Moreiras, MD, PhD,
- Alejandro Diego-Nieto, MD, PhD,
- Manuel Barreiro-Pérez, MD, PhD,
- Ana Martín-García, MD, PhD and
- Pedro L. Sanchez, MD, PhD
- ↵∗Reprint requests and correspondence:
Dr. Juan C. Rama-Merchan, University Hospital of Salamanca, IBSAL, Department of Cardiology, Paseo de San Vicente, Salamanca 37007, Spain.
A 66-year-old woman with a history of atrial fibrillation and previous mitral valve replacement (MVR) underwent new MVR because of dysfunction. After surgery, she was admitted because of recurrent cardioembolic strokes despite optimal treatment with warfarin. Aspirin was added, but the patient had a new stroke. Both MVRs were performed using a right atrial–transseptal approach, and the left atrial appendage (LAA) was ligated.
Transesophageal echocardiography was performed and, incomplete LAA closure with thrombus inside and a dehiscence of the atrial septum suture were detected (Figures 1A to 1C).
After discussion, the decision was made to perform percutaneous closure of the LAA and atrial septal defect in the same procedure. In addition, because of the potential risk for embolization of thrombi from the LAA during the procedure, it was decided to deploy a cerebral protection device (Claret, Claret Medical, Santa Rosa, California).
Once the Claret device was positioned (Figure 1D), LAA closure was performed with a 31-mm Amulet device (St. Jude Medical, St. Paul, Minnesota) (Figure 1E). Subsequently, the atrial septal defect was closed with a 32-mm Amplatzer septal occluder (ASO) (St. Jude Medical) (Figure 1F). Finally, the Claret device was removed.
Three months after the procedure, the patient was asymptomatic, without recurrent strokes. To the best of our knowledge, this is the first case of simultaneous percutaneous closure of the LAA and an atrial septal defect after MVR with a cerebral protection device.
For supplemental videos and their legends, please see the online version of this article.
Dr. Cruz-González is proctor for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Cruz-González and Rama-Merchán contributed equally to this work and should be considered co–first authors.
- Received March 23, 2016.
- Accepted April 7, 2016.
- American College of Cardiology Foundation