title: Percutaneous endocardial occlusion of incompletely surgically ligated left atrial appendage.
abstract: BACKGROUND
  Surgical ligation of the left atrial appendage is considered standard of care in patients who undergo mitral valve surgery or as an adjunct to a surgical Maze procedure for treatment of atrial fibrillation (AF). However, several studies have demonstrated that this can result in incompletely surgically ligated left atrial appendage (ISLL) in a significant number of patients. It is believed that ISLL may in turn promote thrombus formation and lead to clinically relevant thromboembolic events. A novel approach for percutaneous endocardial occlusion of ISLL is described.
  
  
  RESULTS
  Seven patients with AF and ISLL following prior open-chest, surgical suture ligation in the absence of rheumatic heart disease, underwent percutaneous endocardial ISLL occlusion using an Amplatzer Septal Occluder device guided by fluoroscopy and transesophageal echocardiography through a novel approach. Three patients were diagnosed in the setting of acute embolic stroke, 2 at the time of cardiac arrhythmia ablation and 2 by elective precardioversion transesophageal echocardiography. All patients were treated with oral anticoagulation therapy. Acute and long-term ISLL occlusion was successfully achieved in 6 patients, in whom oral anticoagulation was eventually discontinued without any embolic events during 10 ± 2 months of follow-up.
  
  
  CONCLUSIONS
  Percutaneous endocardial occlusion of ISLL is feasible using an Amplatzer Septal Occluder device. Additional studies are required to evaluate the long-term safety and efficacy of this therapeutic treatment strategy in patients with ISLL.
authors.affiliation: Regional Cardiology Associates, Sacramento, California, USA; Mercy Heart & Vascular Institute, Sacramento, California, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.forename: Diogo
authors.initials: D
authors.lastname: Cavaco
authors.forename: Arvin
authors.initials: A
authors.lastname: Arthur
authors.forename: Padraig Gearoid
authors.initials: PG
authors.lastname: O'Neill
authors.forename: Pedro
authors.initials: P
authors.lastname: Adragão
authors.forename: André
authors.initials: A
authors.lastname: D'Avila
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D004699:Endocardium / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device
keywords: Amplatzer Septal Occluder device; anticoagulation; atrial fibrillation; cardiac surgery; left atrial appendage; ligation; stroke