Thoracoscopic stapler-closure of left atrial appendage and epicardial clamp-isolation of pulmonary veins in a patient with non-valvular atrial fibrillation and short bowel: a case report. Issue 1 (6th February 2019)

• Record Type: Journal Article
• Authors: Ohtsuka, Toshiya; Nonaka, Takahiro; Hisagi, Motoyuki; Kogure, Shinya
• Editors: Bonaros, Nikolaos; Dinov, Borislav; Papageorgiou, Nikos; Aziz, Amir; Patel, Peysh A
• Is Part Of: European heart journal. Volume 3:Issue 1(2019)
• Publication Date: 2019-02-06
• Subjects: Non-valvular atrial fibrillation -- Superior mesenteric artery occlusion -- Short bowel syndrome -- Left atrial appendage closure -- Pulmonary vein isolation -- Thoracoscopic surgery -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytz007
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Thromboembolic occlusion of the superior mesenteric artery (SMA) is a serious event in patients with atrial fibrillation (AF). Extensive bowel resection is frequently required, and the resulting short bowel syndrome hampers the intake of anticoagulant or anti-arrhythmic medication. Case summary: We report the case of thoracoscopic surgery consisting of stapler-closure of the left atrial appendage and bilateral epicardial clamp-isolation of the pulmonary veins performed in a 66-year-old male patient with symptomatic persistent non-valvular AF who became unable to take in anticoagulants or anti-arrhythmic drugs because of thromboembolic SMA occlusion and subsequent total resection of the small intestine. The patient has been free from thromboembolic or arrhythmic symptoms during 6 months of follow-up despite taking no anticoagulant or anti-arrhythmic drugs. Electrocardiographic monitoring demonstrated a stable sinus rhythm for 48 h at postoperative Months 3 and 6. Echocardiography manifested an improvement of the left ventricular ejection fraction from a preoperative value of 44–69% at postoperative Month 6. Discussion: The present technique may contribute to treating patients with symptomatic non-valvular AF and a complication similar to that of the present case.