Left Circumflex Artery Occlusion in Chronic Phase After Left Atrial Appendage Closure

Figures

• 

  Figure 1. Computed Tomography Before Watchman Device Deployment Diameter of the LAA orifice measured 23.8 mm in the direction of the LSPV toward the LCx, with a maximum diameter of 31.3 mm oriented diagonally. The shortest distance between the LCx and the LAA orifice was 1.8 mm. LAA = left atrial appendage; LCx = left circumflex artery; LSPV = left superior pulmonary vein.

• 

  Figure 2. Transesophageal Echocardiography Midesophageal View After Watchman Device Deployment (A to D) The compression rate was between 14.3% and 17.7%. Meeting the PASS (position, anchor, size, seal) criteria, the Watchman device was deployed. LA = left atrium.

• 

  Figure 3. Left Circumflex Artery Before the Watchman Procedure, 2.5 Years After the Procedure, and After Percutaneous Coronary Intervention (A) Coronary angiography before deploying the Watchman device showed an intact LCx with no significant stenosis. (B) Coronary angiography 2.5 years after device deployment showed total occlusion of the LCx with collateral circulation observed from the left anterior descending artery and right coronary artery to the distal LCx. (C) Final angiography after PCI showed TIMI flow grade 3 in the LCx. LCx = left circumflex artery; PCI = percutaneous coronary intervention.

• 

  Figure 4. Temporal Changes of the Watchman Device on Computed Tomography Indicating Expansion Over Time, Occluding the Left Circumflex Artery 2.5 Years Later (A) Follow-up CT 6 months after LAAC: The Watchman device had expanded to 29.9 mm in the direction of the LSPV and LCx. (B) At 1 year after LAAC, the device had expanded to 30.2 mm in the direction of the LSPV and LCx. (C) At 2 years after LAAC, the device had expanded to 30.6 mm in the direction of the LSPV and LCx. (D) At 2.5 years after LAAC, the device had expanded to 31.2 mm in the direction of the LSPV and LCx. CT = computed tomography; LAAC = left atrial appendage closure; LCx = left circumflex artery; LSPV = left superior pulmonary vein.