Multimodality imaging in preoperative assessment of left atrial appendage transcatheter occlusion with the Amplatzer Cardiac Plug.
OBJECTIVE
Percutaneous left atrial appendage occlusion (LAAO) with the Amplatzer Cardiac Plug (ACP) emerged as a valid alternative in patients with a formal contraindication to oral anticoagulant therapy. Transoesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA), intracardiac echocardiography (ICE), and conventional cardiac angiography (CCA) are used to evaluate LAA diameters. The aim of our study was to compare pre- and intraprocedural imaging techniques in determining the correct selection of the device size, with a retrospective evaluation of the results obtained at post-procedural CCTA follow-up.


RESULTS
Between September 2009 and July 2013, 66 consecutive patients underwent to LAAO with the ACP at our institution. Preoperative LAA evaluation was realized with TEE, CCTA, ICE, and CCA. Fifty-eight (58) patients underwent to post-procedural CCTA to confirm the LAA complete exclusion, the number and extent of the residual leaks, and the positioning of the device. LAA diameters measured by CCTA correlate with the diameters obtained with CCA and ICE, but they are sized slightly larger than the others. TEE has a lower correlation with every other imaging method and a likely tendency to underestimate. The distribution of the leaks and the positioning of the device in post-procedural CCTA show no substantial differences between the devices used greater or equal to the one selected with CCTA in terms of LAA exclusion.


CONCLUSIONS
The sizing of the device decided using CCTA in the phase of maximum LAA expansion reduces the risk of high-flow leaks and device malposition due to undersizing.
Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy alberto.clemente@ftgm.it.
Alberto
A
Clemente
Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy.
Francesco
F
Avogliero
Department of Cardiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Massa, Italy.
Sergio
S
Berti
Department of Cardiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Massa, Italy.
Umberto
U
Paradossi
Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy.
Giuli
G
Jamagidze
Department of Cardiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Massa, Italy.
Marco
M
Rezzaghi
Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy.
Daniele
D
Della Latta
Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy.
Dante
D
Chiappino
D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D011300:Preoperative Care; D012189:Retrospective Studies; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Amplatzer Cardiac Plug; Cardiac computed tomography angiography; Conventional cardiac angiography; Intracardiac echocardiography; Percutaneous left atrial appendage occlusion; Transoesophageal echocardiography