A case study of a coronary artery occlusion with a left atrial appendage closure device

Abstract

　We report a case of a 65-year-old man with mitral regurgitation and atrial fibrillation. He underwent mitral valve replacement and left atrial appendage closure with the AtriClip device via robotic-assisted cardiac surgery. It was difficult to wean from the cardiopulmonary bypass due to regional hypokinesis in the inferolateral wall of the left ventricle with transesophageal echocardiography (TEE), resulting in ventricular fibrillation. The surgeon could not find the left circumflex artery (LCX) blood flow by fluorescence imaging of indocyanine green; hence, the AtriClip device was removed considering LCX obstruction. Consequently, we observed no regional wall abnormalities in TEE after device removal, and weaning from cardiopulmonary bypass was uneventful. LCX is near the base of the left atrial appendage. Therefore, the regional wall abnormalities of the left ventricle and LCX blood flow with TEE should be confirmed in case of left atrial appendage closure by the AtriClip device.