title: Filling the gap: interventional occlusion of incompletely ligated left atrial appendages.
abstract: OBJECTIVE
  Patients undergoing heart surgery and with history of atrial fibrillation are often treated with intraoperative left atrial appendage (LAA) ligation. Incomplete LAA ligation is often described and can be associated with thrombo-embolic complications. To describe a case series of percutaneous LAA occlusion in patients previously treated with surgical LAA ligation.
  
  
  RESULTS
  Over 179 patients treated with implantation of an LAA-occluder system at our centre, 3 (1.6%) were previously treated with a surgical LAA suture exclusion (2 males, age 74 ± 3 years). Patients 1 and 3 presented a 'hammerhead' LAA morphology with an open neck and were successfully treated with an AGA Cardiac Plug (ACP-St Jude Medical) Device. Patient 2 had a conic monolobar LAA with a small neck, and the occlusion could be performed using a Watchman (Boston Scientific) device. After discharge on dual antiplatelet therapy, all the patients could be switched to single aspirin (ASA) therapy after a 6-week transoesophageal echocardiography control.
  
  
  CONCLUSIONS
  Left atrial appendage occlusion in patient with incomplete surgical ligation using percutaneous LAA occluder devices appears to be feasible, and studies including a larger number of patients are needed.
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dugo
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kostantinou
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Schullte-Hahn
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Nowak
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
authors.forename: K R Julian
authors.initials: KR
authors.lastname: Chun
authors.affiliation: Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany b.schmidt@ccb.de.
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D012086:Reoperation / Q000379:methods; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
keywords: Atrial fibrillation; Percutaneous LAA occlusion; Stroke prevention; Surgically ligation