title: Amplatzer left atrial appendage occlusion through a patent foramen ovale.
abstract: OBJECTIVE
  To assess feasibility and outcomes of left atrial appendage (LAA) closure when using a patent foramen ovale (PFO) for left atrial access.
  
  
  BACKGROUND
  Because of the fear of entering the left atrium too high, using a PFO for left atrial access during LAA occlusion (LAAO) is generally discouraged. We report our single-center experience using a concomitant PFO for LAAO, thereby avoiding transseptal puncture.
  
  
  METHODS
  LAAO was performed with local anesthesia and fluoroscopic guidance only (no echocardiography). The Amplatzer Cardiac Plug (ACP) was used in all patients. After LAAO, the PFO was closed at the same sitting, using an Amplatzer occluder through the ACP delivery sheath. Patients were discharged the same or the following day on dual antiplatelet therapy for 1-6 months, at which time a follow-up transesophageal echocardiogram (TEE) was performed.
  
  
  RESULTS
  In 49 (96%) of 51 patients (35 males, age 70.9 ± 11.9 years), LAAO was successful using the PFO for left atrial access. In one patient, a long tunnel PFO precluded LAAO, which was performed via a more caudal transseptal puncture. In a second patient, a previously inserted ASD occluder precluded LAAO, which was abandoned because of pericardial bleeding. PFO closure was successful in all patients. Follow-up TEE was performed in 43 patients 138 ± 34 days after the procedure. It showed proper sitting of both devices in all patients.
  
  
  CONCLUSIONS
  Using a PFO for LAAO had a high success rate and could be the default access in all patients with a PFO, potentially reducing procedural complications arising from transseptal puncture.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Dezsoe
authors.initials: D
authors.lastname: Koermendy
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: left atrial appendage closure; patent foramen ovale/atrial septal defect; transseptal catheterization