Case report
An 82-year-old woman with a history of hypertension,third-degree atrioventricular block and artery embolization was admitted to hospital because of chest distress and palpitations.She was found to have atrial fibrillation(AF) on an ECG recorder.She didn’t get pacemaker planted in her heart and never took oral anticoagulants(OAC) in the past.Due to the patient’s desire to prevent the embolization and in view of the risk of hemorrhage to take OAC,she was referred for left atrial appendage occlusion(LAAO) with a CHA2DS2-VASc score of 5 and a HAS-BLED score of 3.The left atrial appendage(LAA) ostial diameter was 26mm measured by the pre-procedure cardiac computed tomography.No thrombus was found in the patient’s left atrial(LA) or LAA by CT.The diameter of the landing zone was29.1±2.1mm measured by fluoroscopy and a 34-38mm LAmbre device was deployed ed to close the patient’s LAA.After placing the implant in LAA, left atrial angiogram and TEE were performed to check device positioning,LAA sealing and impingement on surrounding cardiac structures.The fluoroscopy and TEE demonstrated that the device was placed in proper position with no residual leakage and then a tug test by exerting tension to the delivery cable was performed to ensure device stability.The COST(C-the umbrella must be flowered at the distal end of the origin of circumflex artery;O-open fully;S-sealing,peri-device leak≤3 mm;T-tug test)criteria were confirmed before releasing the device completely.The LAAO was procedural successful.However,the patient’s blood pressure suddenly dropped to 60/35mmHg while the operators withdrew the delivery sheath.We tried to elevated patient’s blood pressure by speeding up fluid replacement and using noradrenaline promptly.The fluoroscopy and TEE showed that the device was detached from the landing zone and closed to the mitral valve.We decided to retrieve the device by using forceps(Mousetooth alligator forceps, Alton Medical Limited, China)through a 14F adjustable curved sheath(FlexCath, Medtronic, USA)via femoral access immediately but it didn’t work.The device was trapped in the mitral valve.At once,we contacted the surgeons and the surgical retrieval was been performed subsequently to remove the implant in the heart.The patient’s hemodynamic parameters ultimately got steady after the cardiovascular surgery.