Unexpected Detection of Floating Thrombi in Left Atrium After Left Atrial Appendage Ligation with Atriclip Device: A Case Report

AtriClip device has demonstrated an excellent efficacy, long-term durability and safety of left atrium appendage (LAA) closure. We report, the unexpected postoperative transesophageal echocardiography (TEE) finding of thrombi in left atrium (LA) after deployment of an AtriClip in a 73-year-old man with chronic atrial fibrillation and 3-vessel-coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery and LA appendage ligation. The heart was re-arrested and thrombi were retrieve successfully through a left atriotomy. This case emphasizes the unanticipated role of AtriClip in dislodging the thrombus from LAA, in addition to the importance of sufficient and well-founded imaging (Transesophageal Echocardiogram/ Multidetector Computed Tomography) before and after the deployment of AtriClip device.