Image fusion of integrating fluoroscopy into 3D computed tomography in guidance of left atrial appendage closure

2019 ◽  
Vol 22 (1) ◽  
pp. 92-101 ◽  
Author(s):  
Bin-Feng Mo ◽  
Yi Wan ◽  
Abudushalamu Alimu ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Fusion ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Control Group ◽  
Closure Device ◽  
Transseptal Puncture ◽  
3D Computed Tomography ◽  
Laa Closure

Abstract Aims  We evaluated the feasibility of left atrial appendage (LAA) closure guided by the image fusion of integrating fluoroscopy into 3D computed tomography (CT). Methods and results  A total of 117 consecutive patients who underwent LAA closure with or without the image fusion were matched (1:2). Each LAA closure step of the Image fusion group was guided by the preprocedure CT and image fusion, especially in the plan of LAA measurement and transseptal puncture. All patients were successfully implanted with a WATCHMAN closure device. Comparing the two groups, the mean number of recapture times and the number of devices per patient of the Image fusion group were significantly lower (0.4 ± 0.5 vs. 0.7 ± 0.8, P = 0.031 and 1.0 ± 0.2 vs. 1.1 ± 0.3, P = 0.027, respectively). The one-time successful deployment rate by the support of the image fusion was higher than in the control group (66.7% vs. 44.9%, P = 0.026). Each case of the Image fusion group was completely occluded with one transseptal puncture, while five of the Non-image fusion group required redo transseptal punctures. During the 45-day follow-up, both group cases presented occlusion efficiency and no major adverse cardiac events were observed. Conclusion  Image fusion technique integrating fluoroscopy into the 3D CT is safe and feasible which can be easily incorporated into the procedural work-flow of percutaneous LAA closure. The fusion image can play an important alternative role in the plan of LAA measurement and transseptal puncture site for improving the LAA closure procedure.

scholarly journals Left atrial appendage perforation during appendage angiography treated by percutaneous left atrial appendage closure: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Catherine Champagne ◽  
Nicolas Dognin ◽  
Josep Rodés-Cabau ◽  
Jean Champagne
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Closure Device ◽  
Left Atrial Appendage Closure ◽  
Case Summary ◽  
Device Deployment ◽  
Laa Closure

Abstract Background Pericardial effusion is a common complication of percutaneous left atrial appendage (LAA) closure. Acute management is the cornerstone of pericardial effusion treatment and interrupting the intervention is often required. Case summary A 65-year-old man presented an acute 10 mm pericardial effusion following pigtail contrast appendage injection. A rapid Watchman Flex 24 mm (Boston Scientific) deployment permitted bleeding interruption. A needle pericardiocentesis was achieved in order to prevent any haemodynamical instability. Discussion This case report describes an atypical cause of pericardial effusion and a technique for bleeding control with LAA closure device deployment.

scholarly journals Late left atrial appendage closure device displacement and massive thrombus formation: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Benjamin Sasko ◽  
Oliver Ritter ◽  
Peter Bramlage ◽  
Fabian Riediger
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Closure Device ◽  
Watchman Device ◽  
High Bleeding Risk ◽  
Laa Closure

Abstract Background  Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation therapy for the prevention of stroke in selected patients with atrial fibrillation (AF). Infrequently, left atrial (LA) device-related thrombus formation occurs and it is poorly understood. Thrombus formation due to incomplete covering of the LAA is even rarer and may occur within the first few months after device implantation. Case summary  Here, we present a case of a 68-year-old male patient with permanent AF, drug- and hepatitis induced liver cirrhosis (CILD Score B), and prior aortic valve replacement. The patient had a history of percutaneous LAA closure using a WATCHMAN device. He developed massive peri-device leak and thrombus arising from the space between the device and appendage cleft 2 years after implantation. Because of the high bleeding risk with a HAS-BLED score of 5 points, surgery was chosen as the therapy of choice instead of long-term anticoagulation. The patient was discharged in good clinical condition and has been scheduled for a yearly follow-up. Discussion  This case emphasizes the importance of choosing appropriately sized LAA occluder devices and planning for regular post-interventional follow-ups to minimize the risk of per-device leaks and thrombi.

scholarly journals Thromboembolism Prevention via Transcatheter Left Atrial Appendage Closure with Transeosophageal Echocardiography Guidance

Thrombosis ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
John Palios ◽  
Ioannis Paraskevaidis
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Anticoagulation Therapy ◽  
Atrial Appendage ◽  
Closure Device ◽  
Atrial Septal Aneurysm ◽  
Proper Position ◽  
Leading Role ◽  
Laa Closure

Atrial fibrillation (AF) is an independent risk factor for stroke. Anticoagulation therapy has a risk of intracerebral hemorrhage. The use of percutaneous left atrial appendage (LAA) closure devices is an alternative to anticoagulation therapy. Echocardiography has a leading role in LAA closure procedure in patient selection, during the procedure and during followup. A comprehensive echocardiography study is necessary preprocedural in order to identify all the lobes of the LAA, evaluate the size of the LAA ostium, look for thrombus or spontaneous echo contrast, and evaluate atrial anatomy, including atrial septal defect and patent foramen ovale. Echocardiography is used to identify potential cardiac sources of embolism, such as atrial septal aneurysm, mitral valve disease, and aortic debris. During the LAA occlusion procedure transeosophageal echocardiography provides guidance for the transeptal puncture and monitoring during the release of the closure device. Procedure-related complications can be evaluated and acceptable device release criteria such as proper position and seating of the occluder in the LAA, compression, and stability can be assessed. Postprocedural echocardiography is used for followup to assess the closure of the LAA ostium. This overview paper describes the emerging role of LAA occlusion procedure with transeosophageal echocardiography guidance as an alternative to anticoagulation therapy in patients with AF.

scholarly journals Late presentation of left atrial appendage erosion and perforation by an Amplatzer™ Amulet™ closure device: a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
Ben Wilkins ◽  
Christian L Carranza ◽  
Lars Søndergaard ◽  
Ole De Backer
Keyword(s):  
Case Report ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Case Reports ◽  
Late Presentation ◽  
Pericardial Tamponade ◽  
Atrial Appendage ◽  
Closure Device ◽  
Anatomical Relationship ◽  
Laa Closure

Abstract Background Percutaneous left atrial appendage (LAA) closure may reduce the risk of cardioembolic stroke in patients with non-valvular atrial fibrillation. Given the prophylactic nature of the procedure, identifying and managing complications are paramount. Case summary A 73-year-old man presented 14 months after percutaneous LAA closure with syncope and acute pericardial tamponade which required surgical exploration and haemostasis; the most temporally remote account of this complication albeit amongst very few case reports. Tissue erosion by the Amplatzer™ Amulet™ LAA closure device (Abbott, Plymouth, MN, USA) was noted at two separate anatomical locations, corresponding to the device disc and lobe, which has not been described previously. Discussion This case report highlights the anatomical relationship between the LAA and its surrounding structures, and the importance of recognizing the risk of late device erosion.

Left Atrial Appendage Studied by Computed Tomography to Help Planning for Appendage Closure Device Placement

2010 ◽  
Vol 21 (9) ◽  
pp. 973-982 ◽  
Author(s):  
YAN WANG ◽  
LUIGI DI BIASE ◽  
RODNEY P. HORTON ◽  
TUAN NGUYEN ◽  
PRASANT MORHANTY ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Closure Device ◽  
Device Placement
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