Follow-up
No neurological events occurred during follow up. 6 and 12 months after the procedure, TEE revealed a well-seated 22-mm LACbes device with no residual flow around the device and no device related thrombus (DRT).
Case 2
A 59-year-old male with atrial fibrillation and heart failure presented for hospital. The patient’s CHA2DS2-VASc score was 2 and his HASBLED score was 1. He chose LAAO because of poor compliance with long term oral anticoagulants.
An the beginning of the procedure, TEE revealed a chicken wing shaped LAA free of thrombus. LAA emptying velocity was 28.9 cm/sec and LAA EF 34%, no spontaneous echocardiographic contrast in the LAA. Intravenous heparin 3000U was given after right femoral vein puncture. After TEE-guided trans-septal puncture, a 12F delivery sheath and pigtail catheter were delivered to the left atrial, intravenous heparin 4100U were administered. At this time, TEE suddenly showed a mobile thrombus whose proximal part was connected to the 12F delivery sheath (Figure 3A, 3B and Video 2). Immediately, the ACT measured 161s. Heparin 2000U was added and ACT measured 168s after 5 min. Heparin was added again and we tried to suck the thrombus through the long sheath, thrombus still attached to the outside of the sheath. Cerebral embolic protection devices (ev3 SpiderFX) were implanted in the bilateral internal carotid arteries, TEE showed the amount of thrombus gradually decreased until disappeared. When TEE showed thrombus dissolution, we rechecked ACT which was 260s. Then, a 24-mm LACbes device was implanted with no para-device leak and no thrombus on the device surface. The total heparin dosage used was 18000U. None was showed in the filters after withdraw cerebral protection devices. Rivaroxaban and aspirin were initiated, and the patient was closely monitored post-operation. The neurological function was not impaired after the procedure.