Pulmonary artery perforation and coronary air embolism-two fatal outcomes in percutaneous left atrial appendage occlusion.
Percutaneous left atrial appendage (LAA) closure is a routinely performed method to reduce the risk of stroke in patients suffering from atrial fibrillation, when an oral anticoagulation is no longer indicated due to relevant bleeding complications. Currently, the Amplatzer Amulet and the Watchman system are two equally used systems. While there is an acute success rate of more than 95 per cent for this intervention, several minor and major complications such as pericardial effusions, air embolism, vascular lesions in proximity to the heart or even death can occur. Here, we report two cases of very rare fatal outcomes in percutaneous LAA occlusion. Eight hours after deployment of an Amplatzer Amulet a patient died, after the pulmonary trunk was perforated by a hook of the occluder device causing pericardial tamponade. In the second case during final radiological position control of the deployed Watchman occluder air was injected accidentally. The patient immediately died due to coronary air embolism. Forensic autopsies are necessary to solve the cause and manner of death, to evaluate and develop medical devices and to rule out medical malpractice. Thus, a close collaboration of legal medicine and the various cardiologic departments is proposed.
University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
J
J
Zwirner
University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
R
R
Bayer
University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
C
C
Hädrich
University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany.
A
A
Bollmann
Hospital St. Georg Leipzig, Clinic for Cardiology, Angiology and Intensive Care, Leipzig, Germany.
N
N
Klein
University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
J
J
Dreßler
University of Leipzig, Institute of Legal Medicine, Leipzig, Germany. benjamin.ondruschka@medizin.uni-leipzig.de.
B
B
Ondruschka
D000368:Aged; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000601:surgery; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage; D004618:Embolism, Air / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000473:pathology; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D011651:Pulmonary Artery / Q000293:injuries*; D015641:Radiography, Interventional / Q000009:adverse effects*; D055989:Septal Occluder Device / Q000009:adverse effects*; D012770:Shock, Cardiogenic / Q000209:etiology
D003287:Contrast Media
Amplatzer amulet; Coronary air embolism; Left atrial appendage occlusion; Medical malpractice; Pulmonary artery perforation; Watchman device