title: Transesophageal echocardiographic diagnosis of a WATCHMAN left atrial appendage closure device thrombus 10 years following implantation.
abstract: Left atrial appendage closure with the WATCHMAN device is an alternative to chronic oral anticoagulation for thromboembolic prophylaxis in atrial fibrillation patients. Left atrial device-related thrombus (DRT) has been described in the first year after implant with an incidence of ~6%. A 79-year-old man underwent WATCHMAN device placement in 2006. Routine protocol specified follow-up transesophageal echocardiograms (TEE) at 6 weeks, 6 months, and 1 year following implant showed no evidence for DRT or peri-device flow. A decade after device implant, the patient presented with severe symptomatic aortic stenosis and underwent repeat TEE, which revealed a 21 mm × 18 mm DRT on the LA aspect of the WATCHMAN device. He was prescribed apixaban 5 mg po BID. A TEE performed 111 days later demonstrated marked diminution in the DRT (9 mm in diameter). This case demonstrates that WATCHMAN DRT may occur late following implantation.
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Shariq
authors.initials: S
authors.lastname: Shamim
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Magalski
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Adnan K
authors.initials: AK
authors.lastname: Chhatriwalla
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Keith B
authors.initials: KB
authors.lastname: Allen
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Huber
authors.affiliation: Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Main
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D057505:Embolic Protection Devices / Q000009:adverse effects*; D005500:Follow-Up Studies; D005544:Forecasting; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology
keywords: Left atrial appendage thrombus; TEE