title: Intra-procedural imaging of the left atrial appendage: implications for closure with the Amplatzer™ cardiac plug.
abstract: OBJECTIVE
  To evaluate intra-procedural imaging with transesophageal echocardiography and angiography during left atrial appendage occlusion using the Amplatzer™ Cardiac Plug with regard to sizing and final device shape.
  
  
  METHODS
  Left atrial appendage ostium dimensions and diameter at a depth of 10mm from the ostium were measured by transesophageal echocardiography (0-180°) and angiography (RAO 30° - Cranial 20°) in consecutive patients undergoing left atrial appendage occlusion using the ACP with an oversizing strategy of 10-20% relative to the baseline measurements. After delivery, ACP dimensions were measured and device shape was assessed.
  
  
  RESULTS
  Twenty-seven consecutive patients underwent successful uncomplicated left atrial appendage closure with Amplatzer™ Cardiac Plug. We found a significant difference between the largest and smallest left atrial appendage diameter measured with transesophageal echocardiography (22.3±4.2 vs. 18.1±4.1mm, p<0.001). By the end of the procedure (by angiography), ACP had an optimal shape in 17 patients (63%), a strawberry-like shape in 7 patients (26%), and a square-like shape in 3 patients (11%). ACP was oversized on average by 1.5±2.7 and 3.3±2.3mm compared to transesophageal echocardiography and angiography, respectively. The final shape of the device was not significantly associated with the degree of oversizing.
  
  
  CONCLUSIONS
  We found a considerable variability in the assessment of the left atrial appendage, using transesophageal echocardiography and angiography. The degree of Amplatzer™ Cardiac Plug expansion within the left atrial appendage and the final shape of the device were not associated with the degree of oversizing.
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Ayax
authors.initials: A
authors.lastname: Sobrino
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Alicia
authors.initials: A
authors.lastname: Pulido
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Chan
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Garceau
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. Electronic address: arsene.basmadjian@icm-mhi.org.
authors.forename: Arsène J
authors.initials: AJ
authors.lastname: Basmadjian
mesh_terms: D000368:Aged; D000792:Angiography; D020517:Atrial Appendage / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D055989:Septal Occluder Device; D025321:Surgery, Computer-Assisted
keywords: Atrial fibrillation; Canada; Canadá; Cardiac plug; Ecocardiografía transesofágica; Fibrilación auricular; Infarto cerebral; Left atrial appendage; Orejuela izquierda; Stroke; Transesophageal echocardiography