Giant Left Atrial Appendage and Coronary Fistula With Microvascular Remodeling After Surgical Closure.

Authors

Yuki Ikeshita, Yojiro Machii, Hideaki Kanzaki, Atsushi Okada, Masashi Amano, Yoshihiko Ikeda, Tatsuya Nishii, Takeshi Kitai, Satsuki Fukushima, Chisato Izumi

Published in

JACC. Case reports. Pages 109750. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Left atrial appendage (LAA) closure reduces stroke in patients with atrial fibrillation.
A 63-year-old man with chronic atrial fibrillation had undergone mitral valve replacement and endocardial suture closure of the LAA 5 years before presentation. One year postoperatively, a giant LAA was noted, and coronary angiography revealed a newly developed coronary-LAA fistula. Progressive enlargement of the LAA was confirmed 5 years postoperatively, with expansion of the fistulous tract on coronary angiography, ultimately leading to surgical LAA resection.
Incomplete suture closure might have caused microscopic residual flow and thrombus formation within the LAA despite anticoagulation. Additionally, we speculate that the fistula developed from postoperative microvascular remodeling, potentially serving as a pathway for blood flow into the LAA. LAA resection may represent a reasonable option in selected cases.
Postclosure LAA enlargement, though rare, warrants evaluation for coronary-LAA fistulae because reintervention may be required.

PMID:
42593382
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.