Case Presentation: Gone with the Flow: A Watchman Device’s Aortic Adventure and the Percutaneous Rescue Mission
Presenter
George H Nasr, MD, The University of California, Irvine Medical Center, Orange, CA
David M. Shavelle, M.D., Long Beach Memorial Medical Center, Manhattan Beach, CA
George H Nasr, MD, The University of California, Irvine Medical Center, Orange, CA and David M. Shavelle, M.D., Long Beach Memorial Medical Center, Manhattan Beach, CA
Keywords: Complications and Left Atrial Appendage Closure (LAAC)
Title: Gone with the Flow: A Watchman Device’s Aortic Adventure and the Percutaneous Rescue Mission Introduction: This case report highlights the innovative retrieval of a dislodged Watchman left atrial appendage occlusion device. The case is relevant and interesting due to the rare complication and successful percutaneous retrieval method used. Clinical Case: A 77-year-old male with a history of atrial fibrillation on rivaroxaban and prior embolic cerebrovascular accident (CVA) presented for elective left atrial appendage occlusion to mitigate stroke risk while addressing his high bleeding risk due to occupational hazards as a landscape contractor. Despite initial successful deployment of a 24 mm Watchman device which met PASS criteria with 10-13% compression, post-release reevaluation revealed the device had migrated proximally with significant morphology change with a bigger mitral "shoulder" noted. The patient was monitored for another 60 minutes on the procedure table with serial TEE's to ensure the device did not migrate any further. After transferring the patient to the post-acute care unit (PACU), although initially stable, the patient subsequently developed hypotension and myocardial ischemia, which was attributed to device embolization into the left ventricular outflow tract (LVOT) as noted on bedside transthoracic echo (TTE). Emergent intervention involved sternotomy, manual manipulation of the device, and percutaneous retrieval attempts, culminating in successful device removal via a strategic combination of guide catheters, snares, and forceps. The patient’s recovery was uneventful, and he was discharged two weeks post-operation. Discussion: This case illustrates several critical learning points: the necessity of precise device sizing, deployment monitoring, and the potential for emergent multidisciplinary response to complications arising from left atrial appendage occlusion procedures. The occurrence of device embolization into the LVOT is a rare but serious complication requiring rapid identification and intervention to prevent severe adverse outcomes.