The Chicken‐ W ing Morphology: An Anatomical Challenge for Left Atrial Appendage Occlusion

OBJECTIVES: To describe the particular assessment and closure strategy that was followed in patients with left atrial appendages (LAA) with an early and severe bend. BACKGROUND: The presence of a chicken-wing morphology with an early and severe bend constitutes one of the most difficult anatomical settings for transcatheter LAA occlusion. METHODS: Between November 2009 and December 2012, patients who presented chicken-wing LAA with an early (<20 mm from the ostium) and severe bend (<180°) were identified and included in the analysis. A particular implanting strategy consisting of deploying the distal lobe of the device inside the chicken-wing bend was used in all cases. RESULTS: Among 42 patients who underwent LAA occlusion during the study period, 5 (12%) presented the pre-specified anatomy. Following the mentioned implanting strategy, all patients underwent successful LAA occlusion using the Amplatzer Cardiac Plug (n = 2) and the Amplatzer Amulet (n = 3). Successful occlusion was achieved in all patients. None of them presented any procedural complication. Follow-up transesophageal echocardiography at 3 months showed successful LAA sealing in all patients and no device embolization or thrombosis. CONCLUSIONS: According to our results, the pre-specified closing implantation technique for chicken-wing LAAs with an early and severe bend might be a valid strategy for this challenging anatomical setting. Further cases will be necessary to confirm the results.