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.