Key result
Downsizing LAmbre occluder resolves hypovolemia-induced deformation and achieves complete left atrial appendage seal.
Why the study?
Achieving an optimal seal during percutaneous left atrial appendage closure relies heavily on precise device sizing via transesophageal echocardiography, which is sensitive to left atrial loading conditions.
Case Report (n=1)
No
This case demonstrates that periprocedural hypovolemia from fasting and general anesthesia can cause partial left atrial appendage collapse and device sizing inaccuracies during LAA closure, requiring vigilant intraoperative TEE monitoring and hemodynamic optimization.
Answers are grounded in this paper and cite their sources.
Hemodynamic loading warrants attention during LAA closure to avoid sizing errors; leaves open whether standardized periprocedural protocols improve outcomes.
Background: Percutaneous left atrial appendage closure (LAAO) is an established alternative for stroke prophylaxis in patients with atrial fibrillation (AF) who have absolute contraindications to oral anticoagulation. Achieving an optimal seal relies heavily on precise device sizing via transesophageal echocardiography (TEE)—an imaging modality that is exquisitely sensitive to left atrial loading conditions. Case Summary: We present a patient with a history of AF and prior ischemic stroke who sustained a subarachnoid hemorrhage secondary to warfarin toxicity. Given the prohibitive bleeding risk, the patient was referred for LAAO utilizing the LAmbre device. Under general anesthesia, diminished hemodynamic loading from preoperative fasting precipitated partial LAA collapse. Consequently, an initially selected 24/30 mm LAmbre occluder deformed upon deployment. Prompt echocardiographic recognition of this pressure-volume mismatch enabled safe recapture and the successful implantation of a downsized 22/28 mm device, yielding a flawless seal. Conclusion: This case underscores the profound susceptibility of LAA geometry to periprocedural fluid status. Optimizing hemodynamic parameters and maintaining vigilant intraoperative TEE guidance are paramount to preventing erroneous sizing and ensuring procedural success, especially when navigating complex anatomies with dual-stabilization devices.
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Spec. Dr. Halil İbrahim Tanrıseven (2026) conducted a case report in Atrial fibrillation with warfarin-induced subarachnoid hemorrhage (n=1). Percutaneous left atrial appendage closure (LAAO) with downsized 22/28 mm LAmbre device was evaluated on Successful implantation and optimal LAA seal without residual leaks. Downsizing the LAmbre occluder from 24/30 mm to 22/28 mm resolved device deformation caused by hypovolemia-induced LAA collapse and achieved a complete seal without residual leak.
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