Preprocedural and Postprocedural CT Imaging Can Identify Patients at Risk for Complications After LAA Occlusion

Figures

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  Figure 1. Calculation of ΔA (A) Multiplanar reconstruction (MPR) with cross-hairs demonstrating LAA ostium area prior implant using the 2-chamber plane for orientation and the circumflex coronary artery as anatomical landmark (like transesophageal echo; red arrow). (B) MPR format demonstrating how to assess LAAO device intershoulder area (red arrow) by aligning planes parallel to the widest shoulder distance (ΔA = CT post-LAAO device intershoulder area − CT pre-LAAO ostium area; in example shown below: ΔA = 560 mm2 - 383 mm2 = 177 mm2). ΔA = postimplant change in area; CT = computed tomography; LAA = left atrial appendage; LAAO = left atrial appendage occlusion.

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  Figure 2. Number of Left Atrial Appendage Morphologies in Each Group Abbreviation as in Figure 1.

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  Figure 3. Schematic of LAA Ostium Morphology and Relationship to Events Larger minimum dimensions in left atrial appendage ostium (LAAo) were found to be associated with adverse outcomes. In green box, several examples of cases with no events illustrate the oval morphologies associated with less events when compared to higher incidence of adverse events in subjects with LAAo having larger minimum diameters. DRT = device-related thrombus; PDL = peri-device leak; other abbreviation as in Figure 1.

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  Central Illustration. Multimodality Imaging: Predicting Adverse Events After LAAO CCT = cardiac computed tomography; TIA = transient ischemic attack; other abbreviations as in Figures 1 and 3.