A self-flushing left atrial appendage: a case of a fenestrated left atrial appendage membrane

A left atrial appendage (LAA) membrane is a very rarely seen anatomical variant of undetermined clinical significance. There exists a scarcity of literature on this subject but remains an important structure to identify due to both a purported association with atrial fibrillation, and for physicians preparing for catheter-directed procedures such as LAA occlusion where the presence of a membrane may increase procedural difficulty. We highlight the unique case of an LAA membrane with a focal fenestration resulting in bi-directional shunting and a “self-flushing” LAA.