Page 12 - Journal of Structural Heart Disease Volume 5, Issue 1

Case Report
Journal of Structural Heart Disease, February 2019, Volume 5, Issue 1:1-6
DOI: https://doi.org/10.12945/j.jshd.2019.010.18
Received: April 08, 2018 Accepted: May 01, 2018 Published online: February 2019
Left Atrial Appendage Closure with Double
Watchman Devices: A Case Report
Faisal Alsmadi, MBBS, FRCPC, FACP, FACC, FSCAI, MHRS,
Muhammad Azam Shah, MBBS, FCPS (Cardiology)*, Mohammad Bara Qattea, MD
Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
Abstract
The risk of cardioembolic stroke is high in patients with atrial fibrillation. Antiplatelet agents, vitamin K antagonists, and new oral anticoagulants (NOACs) are effectively used to reduce the risk of thromboem- bolism in high-risk patients. However, increased risks of life-threatening bleeding and narrow therapeutic indexes result in inadequate utilization of these ther- apies. There is growing practice and evidences in favor of closing the left atrial appendage (LAA) percutane- ously by using different devices in patients with either contraindicated or difficult anticoagulation. We report a rare case of a 75-year-old man with atrial fibrilla- tion, high thromboembolic risk (CHADSVASc score of 4), and high bleeding risk score (HASBLED score of 4). He underwent LAA closure using 2 LAA percutaneous closure devices (Watchman) due to bilobed LAA. Con- sidering the great variability in shape and size of the LAA, a single device may not always cover the whole ostium, which leads to residual leaks that can cause a nidus for thrombus formation. Although it technically sounds feasible, a few challenges are associated with double-device implantation. Sealing of the bilobed LAA is technically possible, especially with favorable anatomy, which includes totally separated bodies of both lobes with adequate body sizes.
Copyright © 2019 Science International Corp.
Key Words
Atrial fibrillation • Left atrial appendage closure • WATCHMAN device • Anticoagulation
Introduction
Prevention of cardioembolic stroke is one of the key goals in the treatment of patients with atrial fibril- lation (AF). The risk of embolic stroke with nonvalvu- lar AF is 5.6 times higher [1]. Anticoagulants such as vitamin K antagonists (VKA) and new oral anticoag- ulants (NOACs) are used effectively to reduce the risk of thromboembolism [2]. However, increased risks of mortality, bleeding, and narrow therapeutic indexes result in inadequate utilization of these therapies. There is growing practice and evidence in favor of closing the left atrial (LA) appendage (LAA) percuta- neously by using different devices in patients with ei- ther contraindicated or difficult anticoagulation. Con- sidering the great variability in the shape of the LAA, sometimes, a single device may not cover the whole ostium, which leads to residual leaks that can cause a nidus for thrombus formation. A previous report on double-device LAA closure using an Amplatzer cardi- ac plug (ACP) showed favorable results at follow-up [3]. We report a rare case of a 75-year-old man with AF and high thromboembolic risk who underwent LAA closure using double Watchman devices.
Case Summary
A 75-year-old man who had diabetes, hyperten- sion, hypothyroidism, a post-coronary artery bypass grafting 32 years before, chronic kidney disease (glo-
* Corresponding Author:
Muhammad Azam Shah, MBBS, FCPS (Cardiology)
Department of Cardiology
King Salman Heart Center
Dabab Street, Sulaimaniya, PO Box 59046, Riyadh 11525, Riyadh, Saudi Arabia Tel. +00566539417315; E-Mail: azamshah165@hotmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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