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Case Reports
. 2024 Jan 8;8(1):ytad629.
doi: 10.1093/ehjcr/ytad629. eCollection 2024 Jan.

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

Federico Barocelli  1 , Filippo Luca Gurgoglione  1   2 , Marco Covani  2 , Maria Alberta Cattabiani  3 , Luigi Vignali  1
Affiliations
Case Reports

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

Federico Barocelli et al. Eur Heart J Case Rep. .

Abstract

Background: Transcatheter left atrial appendage occlusion (LAAO) is a valuable therapeutic option for stroke prevention in patients with atrial fibrillation (AF) at high bleeding risk. However, complex LAA anatomies sometimes preclude the adoption of commercially available LAAO devices. The design of a custom-made LAAO device is a promising strategy in these cases. However, few examples of custom-made devices in case of giant LAAs have been reported.

Case summary: An 85-year-old man with permanent AF with CHA2DS2-VASc 4 and recurrent active gastrointestinal major bleedings was referred for transcatheter LAAO at Parma University Hospital after multidisciplinary team evaluation. Pre-procedural coronary computed tomography angiography revealed a giant windsock LAA, with a maximum ostium diameter of 44 mm, a landing zone diameter of 34 mm, and maximal length of 49 mm. Patient's management was particularly challenging given that available LAAO devices were too small to completely exclude the LAA. In accordance with the manufacturer, a custom-made LAmbre™ Closure System (Lifetech Scientific, Shenzhen, China), which specifically fitted with patient's LAA anatomy, was designed and successfully deployed under transoesophageal echocardiography (TEE) and fluoroscopic guidance. Periprocedural TEE confirmed the appropriate position of the device and the absence of peri-device leaks. No adverse ischaemic and haemorrhagic events were reported at 3-months follow-up.

Discussion: We present a case of a successful transcatheter LAAO procedure by deploying a custom-made LAmbre device 38/46 mm to mechanically exclude a giant windsock LAA. This case illustrates the effectiveness of a custom-made device strategy, which potentially enables the closure of all complex LAA anatomies.

Keywords: Atrial fibrillation; Case report; Custom-made device; Giant left atrial appendage; LAmbre™ device; Left atrial appendage occlusion.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Pre-procedural CCTA of patient’s LAA: (A) CCTA three-dimensional reconstruction image showing a giant LAA (white arrow); (B) measurements of the LAA at the level of the ostium, with diameters measuring 44mm × 32 mm; (C) CCTA revealed the presence of a thrombus in the LAA (corresponding to the arrow); (D) ostium maximum diameter: 44 mm; (E) landing zone diameter: 34 mm. CCTA, cardiac computed tomography angiography; LAA, left atrial appendage.
Figure 2
Figure 2
Characteristics of custom-made LAmbre™ device, specifically fitted with patient’s LAA anatomy. LAA, left atrial appendage.
Figure 3
Figure 3
Periprocedural TEE images: (A) pre-procedural TEE image at 50°. (B) Post-procedural TEE at 0° showing the appropriate position of LAmbre™ 38/46 mm. (C) Three-dimensional TEE at 45° showing the disk of the device covering the entrance of LAA. LAA, left atrial appendage; TEE, transoesophageal echocardiography.
Figure 4
Figure 4
Intraprocedural fluoroscopic images of LAAO procedure: (A) contrast injection into LAA. (B) Custom-made LAmbre™ device release. LAA, left atrial appendage; LAAO, left atrial appendage occlusion.
None
See this image and copyright information in PMC

References

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