case_images: PMC10597659_01
case_images: Preoperative cardiac CT angiography reveals a complex left atrial appendage with a large branch, no clear filling defect in the left atrial appendage and left atrium, and no diverticulum and accessory atrial appendage was identified in the left atrium (A) the cross-sectional image of the LAA orifice (B) the long diameter was about 2.4 cm, the short was about 2.2 cm. Oblique view (C) the maximum depth of the left atrial appendage branch was about 4.2 cm. Pericardial effusion.
case_images: fcvm-10-1218582-g001.jpg
case_images: PMC10597659_01_fcvm-10-1218582-g001.jpg
case_images: F1
case_images: No diverticulum or accessory atrial appendage was observed in the left atrium (Figure 1).
case_images: Angiography shows brisk contrast extravasation into the pulmonary artery space.
case_images: fcvm-10-1218582-g002.jpg
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case_images: F2
case_images: Afterwards, we promptly advanced the transseptal sheath and encountered difficulty in accessing the left superior pulmonary vein with the guidewire, while contrast injection indicated visualization of the pulmonary artery (Figure 2).
case_images: Intraoperative view reveals the pulmonary artery perforation caused by mispiercing of the delivery tube sheath. The grey arrows indicate the exit point of the delivery sheath from the roof of the right atrium, while the white arrows indicate its entry into the main pulmonary artery. PA, pulmonary artery; RA, right atrium.
case_images: fcvm-10-1218582-g003.jpg
case_images: PMC10597659_01_fcvm-10-1218582-g003.jpg
case_images: F3
case_images: Exploration was initiated subsequent to the establishment of cardiopulmonary bypass, revealing that the delivery tube sheath had entered through the superior aspect of the right atrium and traversed through the posterior wall of the right pulmonary artery into the main pulmonary artery (Figure 3).