Limits...
Left circumflex coronary artery occlusion due to a left atrial appendage closure device.

Katona A, Temesvári A, Szatmári A, Nemes A, Forster T, Fontos G - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease.With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

View Article: PubMed Central - PubMed

Affiliation: Division of Invasive Cardiology, Department of Cardiology, Albert Szent-Györgyi Clinical Centre, Medical Faculty, University of Szeged, Szeged, Hungary.

ABSTRACT
Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

No MeSH data available.


Related in: MedlinePlus

During positioning of closure device (white arrow), stenosis of circumflex coronary artery (dashed arrow) could be observed both in anteroposterior (A) and lateral views (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4372639&req=5

Figure 0001: During positioning of closure device (white arrow), stenosis of circumflex coronary artery (dashed arrow) could be observed both in anteroposterior (A) and lateral views (B)

Mentions: Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease [1]. This sort of coincidence is not rare. A 59-year-old male patient is presented herein who had undergone coronary angiography in 2003/2004 showing significant stenoses of left anterior descending and right coronary arteries. Left circumflex (CX) showed no significant stenosis at that time. Following percutaneous coronary intervention (PCI) he was free of angina for 10 years. Despite chronic atrial fibrillation, oral anticoagulant therapy was stopped due to repeated head contusions. Left atrial appendage closure was planned to reduce the risk of stroke. The shape of the LAA looked like a glove with a huge ostium. Based on the dimensions of the LAA, the appropriate size of cardiac plug (23 mm) was selected. During the positioning of the device, ECG results changed demonstrating ST-elevations (STE) representing the inferior left ventricular region. Coronary angiography showed compression of the proximal CX causing critical stenosis (dashed arrow) in anteroposterior (Figure 1A) and lateral views (Figure 1B); meanwhile, the device seemed to sit too superficially and not fully configured. Device was immediately retrieved, while STE disappeared. After repositioning of the device (white arrow) deeper in the ostium (Figure 2A) CX-PCI was performed with a drug-eluting stent (Figure 2B) together with kissing dilation (Figure 2C). At the end of the procedure no STE could be demonstrated, the device stayed in a fixed position, and finally no CX stenosis could be seen (Figure 2D). It could be concluded that coronary angiography is recommended before LAA closure to clarify organic lesions.


Left circumflex coronary artery occlusion due to a left atrial appendage closure device.

Katona A, Temesvári A, Szatmári A, Nemes A, Forster T, Fontos G - Postepy Kardiol Interwencyjnej (2015)

During positioning of closure device (white arrow), stenosis of circumflex coronary artery (dashed arrow) could be observed both in anteroposterior (A) and lateral views (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372639&req=5

Figure 0001: During positioning of closure device (white arrow), stenosis of circumflex coronary artery (dashed arrow) could be observed both in anteroposterior (A) and lateral views (B)
Mentions: Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease [1]. This sort of coincidence is not rare. A 59-year-old male patient is presented herein who had undergone coronary angiography in 2003/2004 showing significant stenoses of left anterior descending and right coronary arteries. Left circumflex (CX) showed no significant stenosis at that time. Following percutaneous coronary intervention (PCI) he was free of angina for 10 years. Despite chronic atrial fibrillation, oral anticoagulant therapy was stopped due to repeated head contusions. Left atrial appendage closure was planned to reduce the risk of stroke. The shape of the LAA looked like a glove with a huge ostium. Based on the dimensions of the LAA, the appropriate size of cardiac plug (23 mm) was selected. During the positioning of the device, ECG results changed demonstrating ST-elevations (STE) representing the inferior left ventricular region. Coronary angiography showed compression of the proximal CX causing critical stenosis (dashed arrow) in anteroposterior (Figure 1A) and lateral views (Figure 1B); meanwhile, the device seemed to sit too superficially and not fully configured. Device was immediately retrieved, while STE disappeared. After repositioning of the device (white arrow) deeper in the ostium (Figure 2A) CX-PCI was performed with a drug-eluting stent (Figure 2B) together with kissing dilation (Figure 2C). At the end of the procedure no STE could be demonstrated, the device stayed in a fixed position, and finally no CX stenosis could be seen (Figure 2D). It could be concluded that coronary angiography is recommended before LAA closure to clarify organic lesions.

Bottom Line: Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease.With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

View Article: PubMed Central - PubMed

Affiliation: Division of Invasive Cardiology, Department of Cardiology, Albert Szent-Györgyi Clinical Centre, Medical Faculty, University of Szeged, Szeged, Hungary.

ABSTRACT
Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

No MeSH data available.


Related in: MedlinePlus