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Case Reports
. 2019 Oct 31;12(3):2211.
doi: 10.4022/jafib.2211. eCollection 2019 Oct-Nov.

Transient Left Atrial Appendage Inversion During Transcatheter Closure Device Placement

Waseem Barham  1 , Gaurav Dhar  1 , Nam S Cho  1 , David Rhine  1
Affiliations
Case Reports

Transient Left Atrial Appendage Inversion During Transcatheter Closure Device Placement

Waseem Barham et al. J Atr Fibrillation. .

Abstract

A 72-year-old female patient underwent left atrial appendage closure. During recapture of the occlusion device, transient inversion of the appendageal wall occurred. We describe the mechanism with real-time imaging and share our experience of handling this situation. To the best of our knowledge, this is the first case report of this unique recapture complication.

Keywords: Left atrial appendage inversion; atrial fibrillation; transcatheter closure.

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Figures

Figure 1.
Figure 1.. LAA closure using Watchman device. A: Intraprocedural TEE imaging and measurement of the LAA at baseline. There is no evidence of sludge, thrombus or spontaneous contrast. B: The deployed Watchman device (arrow) measuring 4.4 mm in diameter (9.6% compression).
Figure 2.
Figure 2.. Intraprocedural TEE imaging during recapture of the deployed Watchman device. A: A finger-like projection (arrow head) captured extending into the LA and represents LAA inversion. B: The Watchman device pedicles (arrow) fixated to the inverted LAA wall (arrow head). LA = left atrium.
Figure 3.
Figure 3.. Closure of the LAA with new Watchman device. A: TEE image of the LAA (arrow) after full device recapture and resolution of the inversion. B: Fluoroscopic appendogram revealing no contrast leakage ruling out perforation of the LAA wall. C: New Watchman device deployed and adequately seated in the LAA with a diameter of 20.3 mm (24.8% compression). D: Fluoroscopic image of the new Watchman device with adequate position and compression. E: Doppler TEE revealed adequate seal with no flow around or across the closure device. F: Six-week follow up TEE shows maintenance of adequate seal and no residual peri-device shunt.
See this image and copyright information in PMC

References

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