Large Free-Floating Left Atrial Thrombus After Incomplete Thoracoscopic Closure of the Left Atrial Appendage.

Nagatsuka, Motoki; Asai, Tohru; Noguchi, Kenichiro; Hama, Daisuke; Arai, Chishio; Shimizu, Kunihiko · Ann Thorac Surg · 2026

case_report · Level V

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Abstract

A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced 3 cerebral infarctions and underwent thoracoscopic left atrial appendage closure. Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at left atrial appendage closure may help mitigate the risk of thrombus formation.

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