Application of transesophageal echocardiography in left atrial appendage closer with Amplatzer Cardiac Plug

Abstract

Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP). Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE. Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum, minimum values, and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation. The outcomes of LAA occlusion were analyzed. Results Among 32 patients, 27 cases achieved successful LAA occlusion, including 2 cases with peripheral leakage ≤5 mm, and 5 cases failed occlusion.Among 5 failed closed patients, 3 cases with LAA AAD≥ 30 mm, 1 case with LAA of short depth, and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA. LAA AAD maximum, minimum and LAA depth were (25.9±4.9)mm, (20.0±3.8)mm, (31.0±5.6)mm, respectively, and LAA AOD maximum, minimum diameters were (26.2±6.2)mm, (19.4±4.3)mm, respectively. Among 10 cases with LAA AAD≥30 mm, 7 cases achieved successful LAA occlusion, but 3 cases failed. The implanted device diameter was (26.4±3.8)mm, and device compression rate was (7.6±5.5)%. The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717, respectively. There was no complication but 1 case with pericardial effusion. Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder. The AAD of 2D TEE has the good correlation with ACP occluder′s size, the AADs are important factors which affect the success of LAA occlusion. Key words: Echocardiography, transesophageal; Left atrial appendage; Occlusion; Amplatzer Cardiac Plug