Let it be: fate of a lost closure device.

Abstract

A 76-year-old man with a history of stroke and gastrointestinal bleedings without anticoagulation (CHA2DS2VASc 7, HASBLED 4) was referred to left atrial appendage closure in 2013. Left atrial appendage was tapering and shallow but closure was deemed adequate with a 28 mm Amplatzer cardiac plug (Panel A). Adequate position was confirmed with echocardiography and X-ray before discharge. At 4-month control, the patient had been asymptomatic, but closure device had embolized to aortic arch. Computed tomography angiography (Panel B) or ultrasound (Panel C) images of the aortic arch did not show signs of device thrombosis and blood flow was laminar on both sides of the plug. Percutaneous removal of device was not possible because of severe atherosclerosis and tortuosity of femoral and iliac arteries and surgery was deemed too risky. The patient was treated with aspirin only until 2018 when he...