Bailout Left Atrial Appendage Occlusion as a Salvage Strategy for Acute Cardiac Tamponade

Figures

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  Figure 1. Procedural findings during left atrial appendage (LAA) closure using a Leftear occluder. A: Measurement of the orifice and anchoring zone of the LAA based on angiography in the right anterior oblique caudal projection. B: Fluoroscopic image showing engagement of the hook at the superior margin of the distal umbrella within the LAA (red arrow). C: Transesophageal echocardiography (TEE) demonstrating pericardial effusion consistent with acute tamponade (red arrow). D: TEE short-axis view of the LAA revealing an abnormal color flow signal at the superior basal aspect of the LAA ostium (2 o’clock position; red arrow), suggesting the perforation site.

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  Figure 2. Rescue strategy for left atrial appendage (LAA) perforation. A: Disappearance of abnormal LAA color flow after deployment of a fabric-covered occluder, indicating successful sealing of the perforation. B: Stable pericardial effusion without progression on transesophageal echocardiography after device deployment. C: Transthoracic echocardiography confirming resolution of pericardial effusion.

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  Figure 3. Follow-up imaging. A: Transthoracic echocardiography at 3-month follow-up demonstrating complete resolution of pericardial effusion. B: Cardiac computed tomography at 3 months showing no peridevice leak (red arrow), with persistent delayed contrast opacification within the left atrial appendage (red star), suggestive of incomplete endothelialization.