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- Received September 29, 2008
- Revision received October 10, 2008
- Accepted November 3, 2008
- Published online January 26, 2010.
A 67-year-old man with atrial fibrillation presented with stroke 7 weeks after stapler exclusion of his left atrial appendage (LAA), surgical maze procedure, and bioprosthetic aortic valve replacement. Transesophageal echocardiogram (mid-esophageal view at 90°) noted an excluded LAA without persistent flow and a large mobile echodensity consistent with a thrombus attached to the level of the presumed staple line of the LAA, prolapsing through the mitral valve (Image,Online Video 1). The patient was fully anticoagulated with warfarin and in sinus rhythm. In a recent study, Kanderian et al. (1) described a high rate of unsuccessful surgical LAA closure. There is interest in surgical and percutaneous approaches for closure of the LAA to reduce the risk of stroke. Although surgeons might routinely exclude the LAA by some means, there is little outcome data with transesophageal echocardiography to justify its routine use. Future prospective studies will be necessary to determine which technique of LAA exclusion is best, if any, and if that procedure affords clinical benefit beyond that of warfarin alone.
- Received September 29, 2008.
- Revision received October 10, 2008.
- Accepted November 3, 2008.
- American College of Cardiology Foundation