{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:34Z","timestamp":1753876174855,"version":"3.41.2"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and the most common cause of cardioembolic stroke. The left atrial appendage (LAA) is the main source of thrombus formation in patients with AF. Therapies include use of percutaneous LAA closure devices, or surgical LAA occlusion (LAAO). Despite these options, complete closure of the LAA is not always achieved, and residual communication between the LAA and atrium may result in increased thrombus formation. Although studies have analysed the use of percutaneous measures such as coils, plugs, or second occluder device deployment in LAA with peri-device leak (PDL), use of percutaneous occlude devices in surgically occluded LAA is far less studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present a case of a 79-year-old female patient who underwent LAAO device deployment within a surgically occluded LAA with PDL. She underwent 27\u2005mm LAAO device (WATCHMANTM) deployment and all the P.A.S.S. (Position, Anchor, Size, and Seal) criteria were satisfied. Only 1.4\u2005mm PDL was present. She was continued on apixaban and aspirin post-operatively. Post-operative transoesophageal echocardiogram at 6 weeks demonstrated trivial PDL measuring 1.49\u2005mm. Patient was continued on aspirin and clopidogrel, with discontinuation of apixaban.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Percutaneous LAAO device deployment in previously surgically ligated LAA with incomplete exclusion is a potential therapeutic option for patients with AF and a high bleeding risk seeking a minimally invasive strategy, in an attempt to de-escalate anticoagulation therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae058","type":"journal-article","created":{"date-parts":[[2024,2,4]],"date-time":"2024-02-04T04:59:39Z","timestamp":1707022779000},"source":"Crossref","is-referenced-by-count":0,"title":["The use of percutaneous left atrial appendage occluder device in a patient with prior surgical ligation with incomplete exclusion: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9243-5196","authenticated-orcid":false,"given":"Raef","family":"Fadel","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital , 2799 W Grand Boulevard , Detroit, MI 48202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Essaq","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital , 2799 W Grand Boulevard , Detroit, MI 48202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9128-6128","authenticated-orcid":false,"given":"Waddah","family":"Maskoun","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital , 2799 W Grand Boulevard , Detroit, MI 48202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"2024022909584747100_ytae058-B1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1161\/CIRCULATIONAHA.105.595140","article-title":"Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence","volume":"114","author":"Miyasaka","year":"2006","journal-title":"Circulation"},{"key":"2024022909584747100_ytae058-B2","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2024022909584747100_ytae058-B3","doi-asserted-by":"crossref","first-page":"e003710","DOI":"10.1161\/CIRCEP.115.003710","article-title":"Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation: a first-in-human safety, feasibility, and efficacy study","volume":"9","author":"Panikker","year":"2016","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2024022909584747100_ytae058-B4","doi-asserted-by":"crossref","first-page":"3470","DOI":"10.1093\/eurheartj\/ehw048","article-title":"Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation","volume":"37","author":"Panikker","year":"2016","journal-title":"Eur Heart J"},{"key":"2024022909584747100_ytae058-B5","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jacc.2008.03.067","article-title":"Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography","volume":"52","author":"Kanderian","year":"2008","journal-title":"J Am Coll 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atrial appendage occlusion with Watchman device after incomplete surgical ligation","volume":"15","author":"Manongi","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2024022909584747100_ytae058-B9","doi-asserted-by":"crossref","first-page":"ytad160","DOI":"10.1093\/ehjcr\/ytad160","article-title":"Utilization of WATCHMAN FLX for surgically incomplete left atrial appendage occlusion: a multicentre case series","volume":"7","author":"Golzarian","year":"2023","journal-title":"Eur Heart J Case Rep"},{"key":"2024022909584747100_ytae058-B10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2024022909584747100_ytae058-B11","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1161\/CIRCULATIONAHA.110.976449","article-title":"Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry","volume":"123","author":"Reddy","year":"2011","journal-title":"Circulation"}],"container-title":["European Heart Journal - Case 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