Alberto Clemente1, Francesco Avogliero2, Sergio Berti3, Umberto Paradossi3, Giuli Jamagidze2, Marco Rezzaghi3, Daniele Della Latta2, Dante Chiappino2. 1. Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy alberto.clemente@ftgm.it. 2. Department of Radiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Via Aurelia Sud, Massa 54100, Italy. 3. Department of Cardiology, CNR (National Counsil of Research)/FTGM (Tuscany Region 'Gabriele Monasterio' Foundation), Massa, Italy.
Abstract
AIMS: 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. METHODS AND 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. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: 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. METHODS AND 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. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Witold Streb; Katarzyna Mitręga; Tomasz Podolecki; Magdalena Szymała; Anna Leopold-Jadczyk; Tomasz Kukulski; Zbigniew Kalarus Journal: Cardiol J Date: 2018-03-07 Impact factor: 2.737
Authors: William D Kim; Iksung Cho; Young Doo Kim; Min Jae Cha; Sang-Wook Kim; Young Choi; Seung Yong Shin Journal: Front Cardiovasc Med Date: 2022-02-16