PMID- 37288346
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230610
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 6
DP  - 2023 Jun
TI  - Congenital membranous ostial stenosis of the left atrial appendage as a secondary 
      finding in a patient with ST elevation myocardial infarction: a case report.
PG  - ytad251
LID - 10.1093/ehjcr/ytad251 [doi]
LID - ytad251
AB  - BACKGROUND: Stenoses of the left atrial appendage (LAA) represent a common 
      complication after incomplete surgical ligation. However, the idiopathic entity 
      is very rare. So far, there is uncertainty about the thromboembolic risk and 
      potential benefit of anticoagulation in these patients. We report on congenital 
      ostial stenosis of the LAA as a secondary finding in a patient with myocardial 
      infarction. CASE SUMMARY: A 56-year-old patient presented with acute heart 
      failure secondary to ST elevation myocardial infarction (STEMI) and eventually 
      progressed to cardiogenic shock. A percutaneous coronary intervention and stent 
      placement in the first diagonal branch and in the left anterior descending artery 
      was performed in two sessions. There was a new onset of typical atrial flutter 
      and paroxysmal atrial fibrillation with haemodynamically relevant tachycardia. 
      Before synchronized electrical cardioversion, we performed transoesophageal 
      echocardiography. Left atrial thrombi were ruled out. Surprisingly, we found 
      membranous ostial stenosis of the LAA, resulting in a bidirectional flow pattern. 
      After 28 days of treatment in the intensive care unit the patient had full 
      clinical recovery. DISCUSSION: Given the very rare cases of congenital LAA ostial 
      stenosis, there is uncertainty about the thrombogenicity and the potential 
      benefit of anticoagulation or even a percutaneous closure of the LAA. We discuss 
      possible similarities regarding the thromboembolic risk of patients with an 
      idiopathic narrowing of the LAA to patients with incomplete surgical ligation and 
      patients with a device leak after percutaneous LAA closure. Congenital ostial LAA 
      stenosis represents a clinically relevant condition and may be considered as a 
      potential hazard for thromboembolism.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Hanke, David
AU  - Hanke D
AUID- ORCID: 0000-0001-7549-6619
AD  - Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, 
      Germany.
FAU - Hamadanchi, Ali
AU  - Hamadanchi A
AD  - Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, 
      Germany.
FAU - Schulze, P Christian
AU  - Schulze PC
AD  - Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, 
      Germany.
FAU - Franz, Marcus
AU  - Franz M
AUID- ORCID: 0000-0001-6543-4684
AD  - Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, 
      Germany.
LA  - eng
PT  - Case Reports
DEP - 20230602
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC10243859
OTO - NOTNLM
OT  - Anomaly
OT  - Atrial fibrillation
OT  - Case report
OT  - Left atrial appendage closure
OT  - Membrane
OT  - Stenosis
OT  - Transoesophageal echocardiography
COIS- Conflict of interest: None declared.
EDAT- 2023/06/08 06:42
MHDA- 2023/06/08 06:43
PMCR- 2023/06/02
CRDT- 2023/06/08 04:34
PHST- 2022/08/08 00:00 [received]
PHST- 2022/09/06 00:00 [revised]
PHST- 2023/05/17 00:00 [accepted]
PHST- 2023/06/08 06:43 [medline]
PHST- 2023/06/08 06:42 [pubmed]
PHST- 2023/06/08 04:34 [entrez]
PHST- 2023/06/02 00:00 [pmc-release]
AID - ytad251 [pii]
AID - 10.1093/ehjcr/ytad251 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Jun 2;7(6):ytad251. doi: 10.1093/ehjcr/ytad251. 
      eCollection 2023 Jun.