Printed MDCT 3D models for prediction of left atrial appendage (LAA) occluder device size: a feasibility study

Abstract Background In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure. Methods The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure. Results There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements). Conclusions Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.

Download Full-text

Left Atrial Appendage Closure in a Patient With a Patent Foramen Ovale Septal Occluder Device

JACC: Case Reports ◽

10.1016/j.jaccas.2021.01.017 ◽

2021 ◽

Vol 3 (3) ◽

pp. 508-511

Author(s):

Omar Kousa ◽

Toufik Mahfood-Haddad ◽

Shantanu M. Patil ◽

Himanshu Agarwal ◽

Hussam Abuissa

Keyword(s):

Left Atrial ◽

Patent Foramen Ovale ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Foramen Ovale ◽

Left Atrial Appendage Closure ◽

Septal Occluder Device ◽

Occluder Device

Download Full-text

The value of the left atrial appendage orifice perimeter of 3D model based on 3D TEE data in the choice of device size of LAmbre™ occluder

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-019-01627-4 ◽

2019 ◽

Vol 35 (10) ◽

pp. 1841-1851 ◽

Cited By ~ 2

Author(s):

Dan Jia ◽

Qing Zhou ◽

Hong-ning Song ◽

Lan Zhang ◽

Jin-ling Chen ◽

...

Keyword(s):

Left Atrial ◽

3D Model ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Model Based ◽

Device Size

Download Full-text

Initial experience with post Lariat left atrial appendage leak closure with Amplatzer septal occluder device and repeat Lariat application

Heart Rhythm ◽

10.1016/j.hrthm.2014.06.035 ◽

2014 ◽

Vol 11 (11) ◽

pp. 1877-1883 ◽

Cited By ~ 26

Author(s):

Anand M. Pillai ◽

Arun Kanmanthareddy ◽

Matthew Earnest ◽

Madhu Reddy ◽

Ryan Ferrell ◽

...

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Initial Experience ◽

Amplatzer Septal Occluder ◽

Septal Occluder Device ◽

Occluder Device

Download Full-text

Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009227 ◽

2020 ◽

Vol 13 (10) ◽

Author(s):

Domenico G. Della Rocca ◽

Rodney P. Horton ◽

Nicola Tarantino ◽

Christoffel Johannes Van Niekerk ◽

Chintan Trivedi ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Oral Anticoagulation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Systemic Circulation ◽

Atrial Appendage ◽

Landing Zone ◽

Septal Occluder Device ◽

Occluder Device ◽

Laa Closure

Background: Interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation have been established as a valid alternative to oral anticoagulation in patients at high thromboembolic risk. However, their efficacy on stroke prophylaxis may be compromised owing to incomplete LAA closure. Additionally, the need for an alternative thromboembolic prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available. We aimed at evaluating the feasibility of LAA closure with the novel Gore Cardioform Septal Occluder in patients with incomplete appendage ligation or anatomic features which do not meet the manufacturer’s requirements for Watchman deployment. Methods: Twenty-one consecutive patients (mean age: 72±6 years; 85.7% males; CHA 2 DS 2 -VASc: 4.5±1.4; HAS-BLED: 3.6±1.0) were included. Transesophageal echocardiography was performed within 2 months to assess for residual LAA patency. Results: Fourteen patients had incomplete LAA closure following surgical (n=6) or Lariat ligation (n=8). In 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3 and 18.6±2.8 mm. Successful Cardioform Septal Occluder deployment was achieved in all patients. No peri-procedural complications were documented. Procedure and fluoroscopy times were 46±13 and 14±5 minutes. Follow-up transesophageal echocardiography after 58±9 days revealed complete LAA closure in all patients. Conclusions: Transcatheter LAA closure via a Cardioform Septal Occluder device might be a valid alternative in patients with residual leaks following failed appendage ligation or whose LAA anatomy does not meet the minimal anatomic criteria to accommodate a Watchman device. Graphic Abstract: A graphic abstract is available for this article.

Download Full-text

Classification of Left Atrial Appendage Morphology Using Deep Learning

2020 Design of Medical Devices Conference ◽

10.1115/dmd2020-9018 ◽

2020 ◽

Author(s):

Mikayle A. Holm ◽

Alex Deakyne ◽

Erik Gaasedelen ◽

Weston Upchurch ◽

Paul A. Iaizzo

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Blood Clot ◽

3D Models ◽

Atrial Appendage ◽

Blood Clots ◽

Mri Scans ◽

2D Images ◽

Trained Network

Abstract Atrial fibrillation, a common cardiac arrhythmia, can lead to blood clots in the left atrial appendage (LAA) of the heart, increasing the risk of stroke. Understanding the LAA morphology can indicate the likelihood of a blood clot. Therefore, a classification convolutional neural network was implemented to predict the LAA morphology. Using 2D images of 3D models created from MRI scans of fixed human hearts and a pre-trained network, an 8.7% error rate was achieved. The network can be improved with more data or expanded to classify the LAA from the automatically segmented DICOM datasets and measure the LAA ostia.

Download Full-text

Left atrial appendage (LAA) electrical isolation by Maze‐like catheter substrate modification in presence of LAA‐occluder device: A case report

Clinical Case Reports ◽

10.1002/ccr3.3069 ◽

2020 ◽

Vol 8 (10) ◽

pp. 2021-2024

Author(s):

Simone Zanchi ◽

Lorenzo Bianchini ◽

Stefano Bordignon ◽

Fabrizio Bologna ◽

Shota Tohoku ◽

...

Keyword(s):

Case Report ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Electrical Isolation ◽

Substrate Modification ◽

Occluder Device

Download Full-text

P3730Left atrial appendage perimeter measurement by cardiac CT is superior to transesophageal echocardiography for Watchman device sizing

European Heart Journal ◽

10.1093/eurheartj/ehz745.0584 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Seibolt ◽

D Verma ◽

W Mulroy ◽

A Loli

Keyword(s):

Left Atrial ◽

Cardiac Ct ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Current Standard ◽

Landing Zone ◽

Pearson Coefficient ◽

Watchman Device ◽

Very High ◽

Device Size

Abstract Background Left atrial appendage occlusion with Watchman device traditionally relies on accurate left atrial appendage (LAA) ostium diameter measurement by 2D or 3D transesophageal echocardiogram (TEE). Alternate methods of ostium measurement including area-derived diameter and perimeter-derived diameter using cardiac computed tomography (CT) have been proposed. Purpose We aim to use CT technology with an advanced medical imaging application to measure LAA ostium perimeter for improved pre-procedural device sizing. Methods We performed a retrospective analysis of 92 patients with atrial fibrillation (Afib) who underwent Watchman implantation with pre-procedural TEE and cardiac CT between May 2015 and December 2018. LAA characteristics including ostial or landing zone perimeter, minimum and maximum diameters were acquired utilizing 3mensio Structural Heart Imaging Program. Proposed Watchman device size was estimated utilizing ostium perimeter by CT and compared to the current standard utilizing ostium diameter by 2D-TEE. Both measurements were then compared to actual implanted Watchman device size which met the P.A.S.S. criteria of position, anchor, size and seal. Results Watchman device sizing based on novel LAA landing zone perimeter size by CT had a very high correlation with the actual implanted Watchman size (Pearson coefficient r=0.94, p<0.001). Traditional TEE based Watchman sizing only had a modest correlation with the implanted Watchman size (Pearson coefficient r=0.66, p<0.001). CT predicted Watchman size had a significantly higher agreement compared to current standard TEE based sizing (93.4% vs 47.8%), inter-rater agreement was very high for CT based Watchman sizing compared to current standard TEE based sizing (Cohen's kappa = 0.91 vs Cohen's kappa = 0.32, p<0.001, p<0.001 respectively). Bland-Altman analysis also showed better correlation with CT based sizing compared to TEE (see Figure 1). Figure 1 Conclusion CT LAA perimeter sizing is superior to the current standard TEE based Watchman sizing. Larger, multi-center studies may be necessary to further validate our results.

Download Full-text