Implantation of left atrial appendage occlusion devices and complex appendage anatomy: the importance of transesophageal echocardiography.
Percutaneous delivery of left atrial appendage (LAA) occluding devices represents a novel approach for stroke prevention in patients with atrial fibrillation. Transesophageal echocardiography (TEE) has a pivotal role throughout these procedures, facilitating device size selection and ensuring optimal deployment of the device. We report a case of an LAA occluding device implantation in which apparent proper positioning on fluoroscopy was determined by TEE to be malpositioning with a nonocclusive, perpendicular orientation to the plane of the LAA ostium. This problem appeared to be related to a complex, multilobed LAA anatomy and was readily resolved by repositioning of the device under TEE guidance.
Jorgensen
Jesse
J
Emory University School of Medicine, Atlanta, Georgia, USA.
Palmer
Spencer
S
Kalogeropoulos
Andreas
A
Arita
Takeshi
T
Block
Peter
P
Martin
Randy
R
Lerakis
Stamatios
S
D020517:Atrial Appendage / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011859:Radiography; D020521:Stroke / Q000209:etiology / Q000517:prevention & control