Retrieval Strategies for Embolized Left Atrial Appendage Closure Devices

Figures

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  Figure 1. Amulet Device Outside the Left Atrial Appendage Transesophageal echocardiography demonstrating the 20-mm Amulet device displaced from its intended position within the left atrial appendage, with the device body visible in the left atrial cavity.

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  Figure 2. 3-Dimensional Reconstruction of the Partially Endothelialized Amulet Device En face 3-dimensional transesophageal echocardiographic reconstruction showing the dislodged Amulet device with overlying tissue ingrowth (orange) along its proximal disc, consistent with partial endothelialization.

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  Figure 3. Fluoroscopic Image of the Residual Left Atrial Appendage Stump Fluoroscopy demonstrating catheter manipulation within the small residual left atrial appendage stump following previous surgical amputation (arrow), illustrating the anatomically constrained landing zone encountered during device implantation.

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  Figure 4. Snare Capture of the Embolized Amulet Device in the Aorta Fluoroscopic image showing an EN Snare engaging the embolized Amulet device after its migration into the abdominal aorta, immediately before percutaneous retrieval

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  Figure 5. Transesophageal Echocardiography of the Partially Dislodged Watchman Flx Device 2-dimensional (left) and color Doppler (right) transesophageal echocardiography demonstrating partial dislodgment of the Watchman Flx device with rotation and a peri-device leak, identified by turbulent flow on color Doppler.

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  Figure 6. ONO Retrieval Device Engaging the Dislodged Watchman Flx Fluoroscopic image showing the ONO retrieval basket deployed around the partially dislodged Watchman Flx device during percutaneous transseptal extraction.

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  Figure 7. Chest Radiograph Showing the Embolized Amulet Device in the Ascending Aorta Posteroanterior chest radiograph with the embolized Amulet device (arrow) visualized as a radiopaque structure overlying the mediastinum, confirming its position in the ascending aorta

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  Figure 8. Fluoroscopic Image of the Amulet Device Lodged in the Ascending Aorta Fluoroscopy demonstrating the disc-and-lobe structure of the embolized Amulet device, with its radiopaque markers visible, lodged within the ascending aorta before retrieval.

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  Figure 9. ONO Basket Capturing the Embolized Amulet Device Fluoroscopic image showing the ONO retrieval basket engaging the radiopaque marker of the embolized Amulet device within the aorta during the final stage of percutaneous retrieval.

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  Visual Summary. Location-Guided Retrieval Strategy for Embolized LAAO Devices Tabular summary comparing embolization site, retrieval strategy, vascular access, and clinical outcome across all 4 cases, illustrating that retrieval approach is determined primarily by embolization location. CEP = cerebral embolic protection; LAA = left atrial appendage; LAAO = left atrial appendage occlusion.