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Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report
BACKGROUND: Stenoses of the left atrial appendage (LAA) represent a common complication after incomplete surgical ligation. However, the idiopathic entity is very rare. So far, there is uncertainty about the thromboembolic risk and potential benefit of anticoagulation in these patients. We report on...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243859/ https://www.ncbi.nlm.nih.gov/pubmed/37288346 http://dx.doi.org/10.1093/ehjcr/ytad251 |
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author | Hanke, David Hamadanchi, Ali Schulze, P Christian Franz, Marcus |
author_facet | Hanke, David Hamadanchi, Ali Schulze, P Christian Franz, Marcus |
author_sort | Hanke, David |
collection | PubMed |
description | BACKGROUND: Stenoses of the left atrial appendage (LAA) represent a common complication after incomplete surgical ligation. However, the idiopathic entity is very rare. So far, there is uncertainty about the thromboembolic risk and potential benefit of anticoagulation in these patients. We report on congenital ostial stenosis of the LAA as a secondary finding in a patient with myocardial infarction. CASE SUMMARY: A 56-year-old patient presented with acute heart failure secondary to ST elevation myocardial infarction (STEMI) and eventually progressed to cardiogenic shock. A percutaneous coronary intervention and stent placement in the first diagonal branch and in the left anterior descending artery was performed in two sessions. There was a new onset of typical atrial flutter and paroxysmal atrial fibrillation with haemodynamically relevant tachycardia. Before synchronized electrical cardioversion, we performed transoesophageal echocardiography. Left atrial thrombi were ruled out. Surprisingly, we found membranous ostial stenosis of the LAA, resulting in a bidirectional flow pattern. After 28 days of treatment in the intensive care unit the patient had full clinical recovery. DISCUSSION: Given the very rare cases of congenital LAA ostial stenosis, there is uncertainty about the thrombogenicity and the potential benefit of anticoagulation or even a percutaneous closure of the LAA. We discuss possible similarities regarding the thromboembolic risk of patients with an idiopathic narrowing of the LAA to patients with incomplete surgical ligation and patients with a device leak after percutaneous LAA closure. Congenital ostial LAA stenosis represents a clinically relevant condition and may be considered as a potential hazard for thromboembolism. |
format | Online Article Text |
id | pubmed-10243859 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102438592023-06-07 Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report Hanke, David Hamadanchi, Ali Schulze, P Christian Franz, Marcus Eur Heart J Case Rep Case Report BACKGROUND: Stenoses of the left atrial appendage (LAA) represent a common complication after incomplete surgical ligation. However, the idiopathic entity is very rare. So far, there is uncertainty about the thromboembolic risk and potential benefit of anticoagulation in these patients. We report on congenital ostial stenosis of the LAA as a secondary finding in a patient with myocardial infarction. CASE SUMMARY: A 56-year-old patient presented with acute heart failure secondary to ST elevation myocardial infarction (STEMI) and eventually progressed to cardiogenic shock. A percutaneous coronary intervention and stent placement in the first diagonal branch and in the left anterior descending artery was performed in two sessions. There was a new onset of typical atrial flutter and paroxysmal atrial fibrillation with haemodynamically relevant tachycardia. Before synchronized electrical cardioversion, we performed transoesophageal echocardiography. Left atrial thrombi were ruled out. Surprisingly, we found membranous ostial stenosis of the LAA, resulting in a bidirectional flow pattern. After 28 days of treatment in the intensive care unit the patient had full clinical recovery. DISCUSSION: Given the very rare cases of congenital LAA ostial stenosis, there is uncertainty about the thrombogenicity and the potential benefit of anticoagulation or even a percutaneous closure of the LAA. We discuss possible similarities regarding the thromboembolic risk of patients with an idiopathic narrowing of the LAA to patients with incomplete surgical ligation and patients with a device leak after percutaneous LAA closure. Congenital ostial LAA stenosis represents a clinically relevant condition and may be considered as a potential hazard for thromboembolism. Oxford University Press 2023-06-02 /pmc/articles/PMC10243859/ /pubmed/37288346 http://dx.doi.org/10.1093/ehjcr/ytad251 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Case Report Hanke, David Hamadanchi, Ali Schulze, P Christian Franz, Marcus Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title | Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title_full | Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title_fullStr | Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title_full_unstemmed | Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title_short | Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report |
title_sort | congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with st elevation myocardial infarction: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243859/ https://www.ncbi.nlm.nih.gov/pubmed/37288346 http://dx.doi.org/10.1093/ehjcr/ytad251 |
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