Significant Left Atrial Appendage Leak After LAA Exclusion System Occluded by ASD Closure Device

Visual Summary. Multimodality Imaging Diagnostics and Procedural Approach for Closure of a Severe Left Atrial Appendage Leak After AtriClip Via ASD Occluder

Figure 1. Cardiac CT Images (A and B) Contrast-enhanced axial-plane CT images. (C) CT 3-dimensional reconstruction image of left atrium from an inferior-anterior angle. (A) and (B) demonstrated spontaneous contrast blush at different levels within the LAA, surgical AtriClip in place (arrowheads), and a residual ostium into the LAA (arrow). These can be visualized externally in the 3-dimensional reconstruction image, showing the AtriClip (arrowhead) and nonoccluded area of tissue leading to the LAA (arrow). Note also the severe left atrial dilation. CT = computed tomography; LAA = left atrial appendage.

Figure 2. 3-Dimensional and 2-Dimensional TEE Images (A) Three-dimensional TEE with LAA residual defect (arrow). (B) Three-dimensional TEE with LAA after ASD occluder device placement (arrow). (C) TEE with Doppler demonstrating no residual leak after ASD occluder placement (arrow). ASD = atrial septal defect; TEE = transesophageal echocardiography; other abbreviation as in Figure 1.

Figure 3. Cardiac Catheterization Fluoroscopy Images (A) Fluoroscopy with contrast injection showing LAA leak (yellow arrow) and prior surgical clip (blue arrow). (B) Fluoroscopy after ASD occluder placement (yellow arrow) with prior surgical clip (blue arrow). Abbreviations as in Figures 1 and 2.