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