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CASE20191031_009
| STRUCTURAL HEART DISEASE - Left Atrial Appendage Closure | |
| Two WATCHMAN¢â in Bilobed Left Atrial Appendage | |
| Ruyin Hsu1, Chia-Ti Tsai1 | |
| National Taiwan University Hospital, Taiwan1, | |
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[Clinical Information]
- Patient initials or identifier number:
5878701
-Relevant clinical history and physical exam:
The 69-year-old man who suffered from several times of central-retinal-vascular-occlusion-related left amaurosis fugax was admitted for left atrial appendage closure device placement. He had praroxysmal atrial fibrillation, coronary artery disease, hypertension, diabetes mellitus and hyperlipidemia with regular follow-up in out-patient department.
-Relevant test results prior to catheterization:
EKG: atrial fibrillation
Carotid vascular duplex:1.Mild to moderate atherosclerosis in bilateral CCAs, carotid bulbs, ECAs, and ICAs without significant hemodynamic changes.2.Adequate total VA flow amount. Transesophageal echocardiogram1. Intact interatrial septum, no evidence for an atrial septal defect2. Spontaneous contrast in left atrial appendage3. Moderate AR/MR/TR, mild PR  LAAO before intervention.avi TEE of bilobed.avi- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
The patient received general anesthesia and intracardiac echocardiographi(ICE) probe was advanced to right atrium. We performedthe trans-septal puncture under ICE guided, and advanced left atrial appendage sheath via right femoral vein. Angiographyshowed bilobed left atrial appendage. We inserted another sheath via left femoral vein and guided to anotherlobe. Then the LAA occluders smoothly (WATCHMAN¢â 27mm and 21mm) were implanted smoothly. The postimplatation LAA angiogram revealed good position of LAA occluder. ICE was placed to LA andconfirmed the position of LAA occluder. Minimal leakage was found.
LAAO guiding.avi LAAO deployed.avi LAAO follow up TEE.avi- Case Summary:
Complex left atrial apppendage anatomy may preclude percutaneous occluder placement. In this rare case, we successfully demonstrated WATCHMAN¢â placement to bilobed atrial appendage with mild residual leakage without complication. The follow up trasnsesophageal echocardiography also showed good result. Therefore, catheter based approach of left atrial appendage occluder placment is still an alternative choice for selective cases with complex anatomy.
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