title: Extending percutaneous left atrial appendage closure indications using the AMPLATZER™ Cardiac Plug device in patients with persistent left atrial appendage thrombus: The thrombus trapping technique.
abstract: BACKGROUND
  Percutaneous left atrial appendage (LAA) closure has emerged as an alternative therapeutic option for the prevention of embolic stroke in high-risk patients with non-valvular atrial fibrillation. The presence of thrombus in the LAA is currently a contraindication to the procedure.
  
  
  OBJECTIVE
  To describe a modified LAA closure technique that allows a safe procedure in patients with LAA thrombus.
  
  
  METHODS
  Between May 2013 and October 2014, LAA closure was performed in three patients with LAA thrombus (mean age 73.6±14 years; two men), using a modified technique that avoids manipulation of catheters or angiography in the LAA.
  
  
  RESULTS
  Two patients had persistent thrombus despite appropriate antithrombotic therapy, while the other patient had a contraindication to systemic anticoagulation. The procedure was successful using the modified implantation technique in all patients. The implanted device was the AMPLATZER™ Cardiac Plug (St. Jude Medical, Minneapolis, MN, USA) in one patient and the Amulet™ (St. Jude Medical, Minneapolis, MN, USA) in two patients. No periprocedural complications occurred. After a mean follow-up of 8±2 months, no deaths or late complications were observed.
  
  
  CONCLUSIONS
  Thrombus trapping is a feasible and effective technique for performing LAA occlusion in patients with thrombus within the LAA. This modification of the implantation technique may allow LAA closure indications to be extended to include patients with LAA thrombus, who were formerly considered unsuitable.
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France. Electronic address: jalalzakaria1@gmail.com.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Marie-Lou
authors.initials: ML
authors.lastname: Dinet
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Selly
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Nadir
authors.initials: N
authors.lastname: Tafer
authors.affiliation: Department of Neurology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Renou
authors.affiliation: Department of Neurology, University Hospital of Bordeaux, 33000 Bordeaux, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Sibon
authors.affiliation: Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France; Inserm 1045, University of Bordeaux, 33000 Bordeaux, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Atrial fibrillation; Auricule gauche; Fermeture percutanée; Fibrillation atriale; Left atrial appendage; Percutaneous closure; Thrombus