J Cardiovasc Ultrasound.  2016 Mar;24(1):60-63. 10.4250/jcu.2016.24.1.60.

Heart within a Heart

• Jain T
• Shah J
• Shah S
• Modi S

• KMID: 2160997
• DOI: http://doi.org/10.4250/jcu.2016.24.1.60

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.

Keyword

Atrial fibrillation; Left atrial appendage; Transcatheter occlusion device

MeSH Terms

Aged
Atrial Appendage
Atrial Fibrillation
Diagnosis
Echocardiography
Heart Septal Defects, Ventricular
Heart*
Humans
Male
Stroke
Thrombosis

Figure

• 

  Fig. 1 Zoom in of atrium from apical four chamber view. Unable to appreciate thrombus in this view without the use of contrast.

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  Fig. 2 Heart within a heart. Three chamber view showing a stalk with pedunculated thrombus (arrow).

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  Fig. 3 Contrast-enhanced echocardiogram enhances view of thrombus (arrow).

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  Fig. 4 Transesophageal echocardiogram confirms a large bi-lobed thrombus (arrows).

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  Fig. 5 Transesophageal 3D image shows thrombus attached to ventricular septal defect occluder device (arrow).

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