Cardiac CT and echocardiographic evaluation of peri-device flow after percutaneous left atrial appendage closure using the AMPLATZER cardiac plug device

Autor: Gilbert Puippe, Ulf Landmesser, Andreas R. Luft, Thomas F. Lüscher, Sacha P. Salzberg, Milosz Jaguszewski, Maja Müller, Volkmar Falk, Costantina Manes, Hatem Alkadhi
Rok vydání: 2014
Předmět:
Zdroj: Catheterization and Cardiovascular Interventions. 85:306-312
ISSN: 1522-1946
DOI: 10.1002/ccd.25667
Popis: Objectives: The aim of the study was to examine frequency, size and localization of peri-device leaks after percutaneous left atrial appendage(LAA)-closure with the AMPLATZER-Cardiac-Plug (ACP) by using a multimodal imaging approach, i.e. combined cardiac-CT and TEE follow-up. Background: Catheter-based LAA-occlusion using ACP aims to reduce the risk of stroke in patients with atrial fibrillation. Detection of peri-device leaks after ACP implantation by TEE is challenging, the few available data are inconsistent and the frequency of LAA leaks after ACP implantation remains therefore unclear. Methods: Cardiac-CT using a multi-phase protocol and a second-generation dual-source-CT-system was performed in twenty-four patients with non-valvular atrial fibrillation starting 3 months after LAA-closure by ACP. Color Doppler multiplane TEE was used to evaluate peri-device flow. Results: Cardiac-CT follow-up detected any persistent LAA contrast filling in 62% of patients (n=15), but leak-sizes were small (1.5±1.4mm). Peri-device leaks were almost exclusively localized at the posterior portion of the LAA-orifice (>90%). TEE follow-up revealed peri-device flow in 36% of patients (jet-sizes:≤4mm). ACP-lobe compression (>10 %) and perpendicular ACP-lobe orientation to the LAA-neck axis, that was also dependent on LAA anatomy, were substantially more frequent in patients with complete LAA closure. Conclusion: The present study evaluates for the first time peri-device flow after LAA closure by ACP using a combined cardiac-CT and TEE follow-up. Persistent LAA-perfusion was frequently detected, leak-sizes were small and were less frequent when lobe compression was >10% and lobe orientation was perpendicular to the LAA-neck axis, that was also related to the LAA anatomy. The clinical significance of these small leaks after LAA-closure using ACP needs to be further evaluated in future studies. © 2014 Wiley Periodicals, Inc.
Databáze: OpenAIRE
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