Pulmonary artery perforation after percutaneous left atrial appendage closure: two case reports and review of literature

Abstract

Management of anticoagulant therapy in certain patient populations with atrial fibrillation remains a clinical challenge. In addition to an increased thromboembolic risk, the concomitant bleeding risk significantly contributes to morbidity and mortality in some patients. In recent years, the global use of percutaneous left atrial appendage closure (LAAC) has expanded due to the growing variety of available devices and increasing operator experience. As procedural volumes rise, our understanding of the types and frequencies of related complications continues to evolve. In addition to well-recognized complications such as air embolism, pericardial effusion, and device embolization, rare but catastrophic events like pulmonary artery rupture have also been reported. Our knowledge regarding both the underlying mechanisms and preventive strategies for pulmonary artery rupture is also progressively increasing. In this review, we present two cases of pulmonary artery rupture following percutaneous LAAC performed at our center and provide a comprehensive discussion of risk factors, prevention strategies, and management approaches, incorporating insights from the existing literature.

Keywords: Cardiac tamponade; Device-related complications; Left atrial appendage closure; Pulmonary artery perforation.