Three cases with cardioembolic stroke after left atrial appendage occlusion

Abstract

We reported three cases with cardioembolic stroke after left atrial appendage (LAA) occlusion. First case is 72 years old man with right hemiparesis. His MRI showed acute ischemic lesion in left MCA territory. He was performed endovascular treatment and got complete recanalization. He had a history of his mitral valve replacement and LAA occlusion due to his atrial fibrillation and mitral valve regurgitation. His transesophageal echocardiography (TEE) pointed out fistula between left atrium (LA) and LAA. The second case is 74 years old man who got operation of LAA closure 6 years ago. He suffered from right hemiparesis caused by his MCA M2 occlusion. We examined TEE and found a fistula between LA and LAA. The third case is 72 years old man with right thalamus infarction. TEE showed the very small fistula between LA and LAA detected only by Doppler color flow imaging. It has been reported that subsequent LAA closure associated with cardiac surgery reduces the incidence of stroke. However, incomplete LAA closure was known as cause of stroke. Therefore, we considered it is necessary to perform TEE to observe LAA on the TEE even after LAA closure.