August/September issue of The AFIB Report

The August/September 2014 issue of The AFIB Report is now available

CONTENT

EDITORIAL
CASE STUDY Late LAA leak after LARIAT procedure followed by a small stroke
By Shannon W Dickson
The LARIAT procedure..
An Unwelcome Saturday morning surprise..
To Austin, La Jolla and back again..
Good news and not so good news..
How likely is a post-LARIAT leak and a CVA event to occur... and why?..
"Gunnysacks" and "gotchas"..
All's well that ends well..
The plug procedure..
Back to where we started...a fully sealed and protected LAA..

Lessons learned from my LARIAT repair and CVA experience
Was LAA ligation with the LARIAT worth it in light of the late leak and small stroke?..
Do these rare embolic events associated with late LARIAT leaks arise from thrombus formation or another mechanism?..

[www.afibbers.org]

Hans and Shannon

Hi Shannon

Thanks - interesting read.

Out of interest you mention the LAA is in necrosis. Does that mean it eventually gets broken down?

Regards

Phil

Hi Phil,

Necrosis here implies some degree of atrophy and just becoming a remnant bump in the upper left from side of the left atrium where the full left atrial appendage used to be. Over time in a fully ligated and sealed LAA, endothelial tissue will tend to seal over the seam or original mouth/ostium of the LAA and then the tissue behind that seal on the distal side of a LARIAT suture or Atriclip LAA clamp, both of which are what closes off the LAA as proximal as possible to that inner LAA ostium/Left Atrial juncture, will tend to mostly get resorbed by the left atrium tissue itself and just leave a small lump where the previously open LAA chamber used to be.

I will start another thread here shortly on the topic of my Lariat leak, small stroke and Amplatzer occluder plug repair of the leak a few weeks ago at Scripps for all those who do not get The AFIB Report, as promised.

There are a number of interesting points in which I didn't have enough space to cover in The AFIB Report, such as the fact that I was taking Cardiokinase three times a day when I had that small stroke in any event. That doesn't at all mean the Nattokinase/Cardiokinase is not very useful, it can be helpful, though I would not use it alone in a situation of serious on-going stroke risk in which we need better data and better assurance that it would work as well as the NOACs or warfarin for more urgent needs. But it can be very helpful in milder blood thinning and lysing needs.

Also, keep in mind that quite possible my small CVA event was due to tiny bits of necrotic tissue sloughing off from inside this remnant pouch of my old LAA that had been totally sealed off and undergone a lot of necrotic breakdown before that small leak opened up and caused the stroke 9 months after the Lariat procedure. And thus if that was the case, then its possible nothing much would have prevented it, including NOACs or warfarin, outside of finding and plugging the leak as I've done now, only after the fact.

More on all this later in that thread once I get it up in the next day or so.

Shannon



Edited 1 time(s). Last edit at 08/14/2014 09:46PM by Shannon.

Thanks for a great report, sorry to hear you had gone through all that . Hopefully all is well!!

John