Overcoming Whale Tail Anatomy: Cardiac CT-Guided LAA Occlusion Using the Sandwich Deployment Technique

Anticoagulation. However, anatomical variants such as the bilobar “whale-tail” morphology pose unique challenges for successful percutaneous exclusion. We present a case in which multimodality imaging, including transesophageal echocardiography (TEE), 3D reconstruction, and cardiac computed tomography angiography (CTA)—was critical for procedural planning and execution. A tailored “sandwich” deployment technique, previously described in chicken-wing morphologies, was adapted to achieve secure closure of the whale-tail LAA. To our knowledge, this represents the first reported case of this technique being employed for this specific configuration. This case illustrates the importance of individualized, image-guided strategies in managing anatomically complex LAA morphologies and expands the application of advanced closure techniques.