Abstract
BackgroundA standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography (cCTA) has never been investigated.MethodscCTA datasets were acquired on a 3rd generation dual-source CT system and reconstructed with a slice thickness of 0.5 mm. An interdisciplinary evaluation was performed by two interventional cardiologists and one radiologist on a 3D multi-planar workstation. A standardized multi-planar reconstruction algorithm was developed in order to assess relevant clinical aspects of implanted LAA occlusion devices being outlined within a pictorial essay.ResultsThe following clinical aspects of implanted LAA occlusion devices were evaluated within the most appropriate cCTA multi-planar reconstruction: (1) topography to neighboring structures, (2) peri-device leaks, (3) coverage of LAA lobes, (4) indirect signs of neo-endothelialization. These are illustrated within concise CT imaging examples emphasizing the potential value of the proposed cCTA imaging algorithm: Starting from anatomical cCTA planes and stepwise angulation planes perpendicular to the base of the LAA devices generates an optimal LAA Occluder View for post-implantation Evaluation (LOVE). Aligned true axial, sagittal and coronal LOVE planes offer a standardized and detailed evaluation of LAA occlusion devices after percutaneous implantation.ConclusionsThis pictorial essay presents a standardized imaging proposal by cCTA using multi-planar reconstructions that enables systematical follow-up and comparison of patients after LAA occlusion device implantation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-016-0127-y) contains supplementary material, which is available to authorized users.
Highlights
A standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography has never been investigated
Cardiac CTA protocol and image reconstruction advice for post-implantation evaluation of LAA occlusion devices Based on our experience, cardiac computed tomography angiography (cCTA) protocols for the evaluation of LAA occlusion devices do not require significant protocol adjustments, when compared to standard cCTA protocols being performed for the evaluation of coronary artery stenosis [21,22,23,24]
Clinical scenarios reflecting relevant clinical aspects after implantation of LAA occlusion devices Imaging reports about percutaneously implanted LAA occlusion devices should focus on the following important clinical aspects: Morphologic and topographic aspects of LAA occlusion device positioning
Summary
A standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography (cCTA) has never been investigated. A standardized multi-planar reconstruction algorithm was developed in order to assess relevant clinical aspects of implanted LAA occlusion devices being outlined within a pictorial essay. The implantation of LAA occlusion devices in patients with atrial fibrillation was shown to prevent cardio-embolic stroke as safe and effective as the treatment with the oral anticoagulant warfarin in patients eligible for oral anticoagulation [2,3,4,5,6,7,8,9,10]. The chicken wing was shown to be associated with lowest rates of cardio-embolic stroke compared to all other LAA morphologies [12]
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