Endocardial occlusion of incompletely surgically ligated left atrial appendage using an Amplatzer septal occluder device

A 55-year-old man underwent a surgical Maze procedure for the treatment of nonvalvular atrial fibrillation with concomitant surgical suture ligation of left atrial appendage (LAA). Baseline transesophageal echocardiography (TEE) and computed tomography (CT) angiography revealed a normal LAA free of thrombus (A). Ten days after surgery, he developed an acute embolic stroke. Repeat TEE and CT angiography demonstrated an incompletely surgically ligated LAA (ISLL) without thrombus, with the ISLL neck dimensions measuring 3 × 3 mm (B). He was promptly initiated on oral anticoagulation (OAC) therapy. But owing to intolerance to long-term OAC, he eventually underwent percutaneous endocardial ISLL occlusion by using an Amplatzer septal occluder (ASO) device (St Jude Medical, Inc, Saint Paul, MN), guided by TEE and angiography. Briefly, a 4.0 × 20 mm percutaneous transluminal angioplasty balloon catheter (EverCross, ev3 Endovascular, Inc, Plymouth, MN) was advanced into the ISLL transseptally over a 0.035-inch guidewire to precisely size the ISLL neck diameter. The balloon and guidewire were then exchanged for a 5-mm ASO device, subsequently “unsheathed” such that the distal ASO disc was deployed inside the ISLL, the waist within the neck, and the proximal disc overlying the left atrial surface. Follow-up TEE and CT angiography 6 weeks after the procedure confirmed complete ISLL occlusion in the absence of device-related thrombus (C). At that time, OAC was discontinued and subst...
Source: Heart Rhythm - Category: Cardiology Authors: Tags: Image Source Type: research