Residual Left Atrial Appendage After Incomplete Surgical Closure

Figures

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  Visual Summary. Visual Depiction of Residual LAA Gaps After Surgical AtriClip Placement and Implications for Transcatheter Occlusion Visual representation of the LAA residual gap left by the surgically placed AtriClip. Case 1 demonstrated a large gap (2.73 mm × 4.3 cm) due to distal clipping of the appendage, which was then amenable to placement of a Watchman device. Case 2 demonstrated a residual gap of <10 mm due to proximal clipping of the appendage, which was deemed unsuitable for an appendage occlusion device. LAA = left atrial appendage.

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  Figure 1. Intraprocedural Imaging of Residual LAA and AtriClip Intracardiac echocardiography and fluoroscopy during transcatheter LAA closure showing the residual patent LAA and the distal placement of the prior AtriClip device. The clip is visualized at the apex of the LAA with substantial remaining appendage lumen. LAA = left atrial appendage.

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  Figure 2. Comparative CT Images of the Residual Appendages Cardiac CT images from both cases demonstrating (Top Row) the size of the LAA ostia and (Bottom Row) the residual appendages with measurements. In case 1, there was a large 2.73 mm × 4.3 cm residual gap due to distal clipping of the appendage. In case 2, the residual gap was <1 cm given more proximal clipping of the appendage. CT = computed tomography; LAA = left atrial appendage.