SHM Converge Scientific Abstract ePoster Gallery-Irony of Left Atrial Appendage Occluder- Stroke Preventer or Culprit?

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This case report highlights a rare but serious complication of left atrial appendage occlusion (LAAO), a procedure usually used to reduce stroke risk in atrial fibrillation patients who also have high bleeding risk. A 66-year-old man with atrial fibrillation underwent LAAO because he could not afford warfarin. During the procedure, air was seen in the left ventricle and aspirated, but about one hour later he developed left-sided weakness after sedation was reduced. MRI confirmed cerebral air embolism involving the right middle cerebral artery.<br /><br />He was treated urgently with hyperbaric oxygen for six hours. During treatment, he developed a seizure and required intubation for airway protection, which prolonged his hospitalization. By discharge, his neurological deficits had largely resolved.<br /><br />The discussion emphasizes that cerebral air embolism is uncommon and usually occurs in iatrogenic settings such as catheterization, lung biopsy, or cardiopulmonary bypass. It may occur if air enters the venous system and passes to the arterial circulation, especially in the presence of a shunt. Immediate recognition and removal of the air source are critical. Recommended positioning includes Trendelenburg and right lateral decubitus to limit air migration. Hyperbaric oxygen is the main treatment and should not be delayed, even if imaging is not yet confirmatory.<br /><br />The authors note that cerebral air embolism is not typically associated with LAAO, but it has been reported rarely; in the EWOLUTION registry, only 3 cases were found among 1021 patients. The case underscores that while LAAO can prevent stroke, it can also, rarely, become the cause of an acute embolic stroke.

Asset Subtitle

Sourabh Khatri

Meta Tag

Author List Anjana Chandrasekhara Pillai, Deeksha N. Acharya, Hetal Boricha, Sourabh Khatri

Category Clinical Vignettes

Concept Left Atrial Appendage Occlusion

Concept Arterial Air Embolism

Concept Air Embolic Stroke

Concept Hyperbaric Oxygen Therapy

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization UPMC- McKeesport

Presenting Author Sourabh Khatri

Track Adult

Keywords

left atrial appendage occlusion

cerebral air embolism

atrial fibrillation

hyperbaric oxygen therapy

embolic stroke

middle cerebral artery

iatrogenic complication

air embolus

MRI diagnosis

Trendelenburg positioning

Left Atrial Appendage Occlusion

Arterial Air Embolism

Air Embolic Stroke

Hyperbaric Oxygen Therapy

Neurologic Deficit