Embolization of Amplatzer septal occluder from left atrial appendage

An 80-year-old woman with symptomatic rheumatic mitral valve disease and chronic atrial fibrillation was admitted for mitral valvuloplasty and interventional occlusion of the left atrial appendage. Mitral commissurotomy had been performed 30 years earlier. Because of unstable INR with warfarin therapy, she was at increased risk for bleeding and thromboembolism. The left atrium was grotesquely dilated (10.3 4.6 cm) and showed spontaneous echo contrast. Severe calcification of the mitral valve and mitral annulus resulted in significant stenosis (mitral valve area 1.0 cm2, mean pressure gradient 11 mm Hg)