Percutaneous Closure of a Left Atrial Pseudoaneurysm After Left Atrial Appendage Closure.

BACKGROUND: Left atrial appendage closure (LAAC) is increasingly used for stroke prevention in atrial fibrillation, but rare structural complications may occur and require percutaneous treatment. CASE SUMMARY: A 76-year-old man with atrial fibrillation/flutter was referred for LAAC after LAA thrombus was found on transesophageal echocardiography despite therapeutic anticoagulation. A "no-touch" strategy was planned. The device was deployed in FLX-ball configuration and advanced gently without resistance. However, transesophageal echocardiography and angiography demonstrated deployment within an outpouching adjacent to the true LAA. The device was recaptured, advanced into the true LAA, and LAAC was completed. Postprocedural computed tomography demonstrated a likely iatrogenic pseudoaneurysm, which was successfully closed 2 days later using an Amplatzer ventricular septal defect occluder. DISCUSSION: This case highlights multimodality imaging and transcatheter management of an iatrogenic left atrial pseudoaneurysm after LAAC. TAKE-HOME MESSAGES: LA pseudoaneurysm is a rare complication of LAAC. Multimodality imaging can identify the defect and guide percutaneous closure.