title: The chicken-wing morphology: an anatomical challenge for left atrial appendage occlusion.
abstract: OBJECTIVE
  To describe the particular assessment and closure strategy that was followed in patients with left atrial appendages (LAA) with an early and severe bend.
  
  
  BACKGROUND
  The presence of a chicken-wing morphology with an early and severe bend constitutes one of the most difficult anatomical settings for transcatheter LAA occlusion.
  
  
  METHODS
  Between November 2009 and December 2012, patients who presented chicken-wing LAA with an early (<20 mm from the ostium) and severe bend (<180°) were identified and included in the analysis. A particular implanting strategy consisting of deploying the distal lobe of the device inside the chicken-wing bend was used in all cases.
  
  
  RESULTS
  Among 42 patients who underwent LAA occlusion during the study period, 5 (12%) presented the pre-specified anatomy. Following the mentioned implanting strategy, all patients underwent successful LAA occlusion using the Amplatzer Cardiac Plug (n = 2) and the Amplatzer Amulet (n = 3). Successful occlusion was achieved in all patients. None of them presented any procedural complication. Follow-up transesophageal echocardiography at 3 months showed successful LAA sealing in all patients and no device embolization or thrombosis.
  
  
  CONCLUSIONS
  According to our results, the pre-specified closing implantation technique for chicken-wing LAAs with an early and severe bend might be a valid strategy for this challenging anatomical setting. Further cases will be necessary to confirm the results.
authors.affiliation: Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.forename: Arsène
authors.initials: A
authors.lastname: Basmadjian
authors.forename: Patrick
authors.initials: P
authors.lastname: Garceau
authors.forename: Rèda
authors.initials: R
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000473:pathology* / Q000601:surgery; D001281:Atrial Fibrillation / Q000473:pathology; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male