Applications designed to successfully implant in challenging left atrial appendage occlusion cases: a new tool for the interventional cardiologist

Fig. 1. a1 and a2 Transesophageal echocardiography (TEE) of the left atrial appendage in X-plane view (65/-24). b1 and b2: the image shows a non-appropriate orientation and apposition with the 28 mm AMULET device. c Angiography showing a lack of compression on the device and although there was no contrast inside it was decided not to release the device. With the use of FEops application a 34 mm Amulet device was implanted and released after checking good apposition and compression. d tridimensional TEE image of the device. e1, e2 and f TEE and angiographic images showing correct colocation of the Amulet device

Fig. 2. Top row: Superior CT reconstruction of the left atrial appendage (LAA) (*), seen progressively rotating from extreme posterior (a–f) to anterior projection counterclockwise. LSPV-left superior pulmonary vein. LIPV-left inferior pulmonary vein. Bottom row. Analysis received from FEops application. a Left atrial and LAA seen in anterior and lateral LAA projections. Blue lines: ostium and landing zone measurements of LAA. b Simulations with 3 sizes of Amplatzer™ Amulet™ devices 28, 31 and 34 mm. From this last one, proximal or distal implant and apposition degree are also simulated. c Size (34 mm) and shape of the chosen implant (distal) and the result of the real implant in the procedure