Percutaneous Coiling for Late-Acquired Peri-Device Leak Following Left Atrial Appendage Occlusion

Figures

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  Figure 1. Immediate and Short-Term Left Atrial Appendage Closure Results Assessment (A) Immediate post-implantation left atrial appendage angiography. (B) Six-week control transesophageal echocardiogram following the initial left atrial appendage closure procedure revealed no peri-device leak or residual filling. The maximal device lobe diameter (yellow double-headed arrow) was 19 mm.

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  Figure 2. 6-Year Follow-Up Computed Tomography Scan (A) Computed tomography performed 6 years after the initial procedure revealed an excessive device disc protrusion (red arrow). (B) Computed tomography scan reconstruction identified a semicircular posterosuperior peri-device leak (red arrow) and residual left atrial appendage filling. The maximal device lobe diameter was 22 mm (yellow double-headed arrow).

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  Figure 3. Preoperative Transesophageal Echocardiogram Results (A) Pre-operative transesophageal echocardiogram analyses identified residual flow between the device lobe and the appendage wall (red arrow) related to the peri-device leak. (B) The device disc was in a more proximal position, and the lobe was less compressed (diameter: 21.5 mm) compared with the initial transesophageal echocardiogram (Figure 1B).

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  Figure 4. Percutaneous Left Atrial Appendage Coiling Procedure (A, B) Left atrial appendage was catheterized with a 2.7-F microcatheter within the gap, using a transeptal approach. Five vascular coils were deployed into the appendage successfully. (C) Final angiography following complete coiling revealed no residual filling.

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  Figure 5. 1-Month Follow-Up Computed Tomography Scan The computed tomography scan depicted a left atrial appendage fully “jacketed” with coils without any identified residual left atrial appendage patency.