title: Percutaneous interventions for left atrial appendage exclusion: options, assessment, and imaging using 2D and 3D echocardiography.
abstract: Percutaneous left atrial appendage (LAA) exclusion is an evolving treatment to prevent embolic events in patients with nonvalvular atrial fibrillation. In the past few years multiple percutaneous devices have been developed to exclude the LAA from the body of the left atrium and thus from the systemic circulation. Two- and 3-dimensional transesophageal echocardiography (TEE) is used to assess the LAA anatomy and its suitability for percutaneous closure to select the type and size of the closure device and to guide the device implantation procedure in conjunction with fluoroscopy. In addition, 2- and 3-dimensional TEE is also used to assess the effectiveness of device implantation acutely and on subsequent follow-up examination. Knowledge of the implantation options that are currently available along with their specific characteristics is essential for choosing the appropriate device for a given patient with a specific LAA anatomy. We present the currently available LAA exclusion devices and the echocardiographic imaging approaches for evaluation of the LAA before, during, and after LAA occlusion.
authors.affiliation: Cardiovascular Center Darmstadt, Darmstadt, Germany.
authors.forename: Nina C
authors.initials: NC
authors.lastname: Wunderlich
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; The Heart Institute, Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Swaans
authors.affiliation: Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Siew Yen
authors.initials: SY
authors.lastname: Ho
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: robert.siegel@cshs.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D062645:Percutaneous Coronary Intervention; D020521:Stroke / Q000517:prevention & control
keywords: 2D echocardiography; 3D echocardiography; left atrial appendage; percutaneous closure