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Multiple systemic paradoxical embolisation of a lower limb deep vein thrombosis due to interatrial septal puncture: a rare complication of left atrial appendage occlusion
  1. Kevin Patrick Millar1,
  2. Rory Gallen1,
  3. Ihsan Ullah1 and
  4. Samer Arnous2
  1. 1Cardiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
  2. 2University Hospital Limerick, Dooradoyle, Limerick, Ireland
  1. Correspondence to Dr Kevin Patrick Millar; kevinmillar{at}


A 75-year-old woman with a history of intracranial haemorrhage, atrial fibrillation and coronary artery bypass graft underwent elective left atrial appendage occlusion (LAAO) for stroke prevention. The procedure was successful, however on the third postoperative day, she presented with a lymph leak at the right femoral venous access site. She was admitted for conservative management of the lymph leak with immobility and intravenous fluids. Her inpatient stay was complicated by a right lower limb deep vein thrombosis (DVT), left middle cerebral artery territory ischaemic stroke, pulmonary emboli (PEs) and a splenic infarction. The mechanism of the systemic emboli was that of paradoxical emboli from the DVT passing through an interatrial septal defect created as part of the LAAO procedure, a previously unreported complication of LAAO. She was managed with 6 months of low-dose oral anticoagulation for treatment of DVT and PE and has made a full neurological recovery.

  • interventional cardiology
  • venous thromboembolism
  • stroke
  • arrhythmias

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  • Contributors All authors contributed to the diagnosis and management of the patient and were active in the authorship, research and proofing of the final manuscript. KPM attended the patient as an inpatient, performed the preprocedure transoesophageal echo, consented the patient and wrote the case report. RG provided assistance in writing the manuscript. IU and SA supervised and directed patient management and provided editorial feedback on the manuscript. SA performed the left atrial appendage occlusion with the assistance of IU.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.