title: Left-atrial-appendage occluder migrates in an asymptomatic patient.
abstract: Percutaneous closure of the left atrial appendage (LAA) is a new approach to the prevention of cardioembolic events in patients with atrial fibrillation. We implanted an LAA occlusion device (Amplatzer™ Cardiac Plug) in a 70-year-old woman via a transseptal approach. Upon her discharge from the hospital, a transthoracic echocardiogram showed stable anchoring of the device; 6 months after implantation, a routine transthoracic echocardiogram revealed migration of the occluder into the left ventricular outflow tract, in the absence of symptoms. We surgically removed the device from the mitral subvalvular apparatus and closed the LAA with sutures. This case shows that percutaneous LAA occlusion can result in serious adverse events, including device migration in the absence of signs or symptoms; therefore, careful follow-up monitoring is mandatory.
authors.affiliation: Department of Cardiovascular Surgery (Drs. Fabbrocini, Medici, Pisani, and Sandrelli), NCC Città di Alessandria Hospital, 15121 Alessandria; and Department of Cardiovascular Surgery (Dr. Tesler), Policlinico di Monza, Clinica San Gaudenzio, 28100 Novara; Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pisani
authors.affiliation: Department of Cardiovascular Surgery (Drs. Fabbrocini, Medici, Pisani, and Sandrelli), NCC Città di Alessandria Hospital, 15121 Alessandria; and Department of Cardiovascular Surgery (Dr. Tesler), Policlinico di Monza, Clinica San Gaudenzio, 28100 Novara; Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Sandrelli
authors.affiliation: Department of Cardiovascular Surgery (Drs. Fabbrocini, Medici, Pisani, and Sandrelli), NCC Città di Alessandria Hospital, 15121 Alessandria; and Department of Cardiovascular Surgery (Dr. Tesler), Policlinico di Monza, Clinica San Gaudenzio, 28100 Novara; Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Fabbrocini
authors.affiliation: Department of Cardiovascular Surgery (Drs. Fabbrocini, Medici, Pisani, and Sandrelli), NCC Città di Alessandria Hospital, 15121 Alessandria; and Department of Cardiovascular Surgery (Dr. Tesler), Policlinico di Monza, Clinica San Gaudenzio, 28100 Novara; Italy.
authors.forename: Ugo Filippo
authors.initials: UF
authors.lastname: Tesler
authors.affiliation: Department of Cardiovascular Surgery (Drs. Fabbrocini, Medici, Pisani, and Sandrelli), NCC Città di Alessandria Hospital, 15121 Alessandria; and Department of Cardiovascular Surgery (Dr. Tesler), Policlinico di Monza, Clinica San Gaudenzio, 28100 Novara; Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Medici
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D020878:Device Removal; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Atrial appendage; atrial fibrillation/complications; foreign-body migration/complications; prosthesis failure; stroke/prevention & control; thromboembolism/prevention & control; warfarin/contraindications/therapeutic use