Key result
Percutaneous peri-device leak closure achieves ~83% procedural success, with CCTA yielding larger measurements than TEE.
Why the study?
Peri-device leak (PDL) occurs in 30% to 40% of patients after left atrial appendage occlusion and is associated with thromboembolic events, yet data on the anatomical characteristics of the left atrial appendage in patients developing PDL are limited.
What are the cardiac imaging characteristics (TEE and CCTA) and procedural outcomes of percutaneous peri-device leak (PDL) closure in patients with incomplete left atrial appendage occlusion?
Observational (n=23)
Yes
What are the cardiac imaging characteristics (TEE and CCTA) and procedural outcomes of percutaneous peri-device leak (PDL) closure in patients with incomplete left atrial appendage occlusion?
Percutaneous closure of peri-device leaks after left atrial appendage occlusion is feasible with an 83% procedural success rate and minor complications, while CCTA provides larger and more detailed anatomical measurements than TEE.
Answers are grounded in this paper and cite their sources.
Anatomical LAA features linked to PDL remain incompletely defined; this small retrospective series leaves open optimal imaging and closure strategies.
Background Peri-device leak (PDL) after left atrial appendage occlusion (LAAO) has been reported at 30% to 40% in the literature. PDLs have been associated with thromboembolic events. There are limited data on the anatomical characteristics of the left atrial appendage (LAA) in patients developing PDL. Methods A retrospective analysis of 23 patients undergoing PDL closure between January and December 2024 was performed. Transesophageal echocardiogram (TEE) and/or cardiac computed tomography angiography (CCTA) were performed before and after LAAO and PDL closure. Procedural success was determined intraoperatively with TEE. Results The cohort included 23 patients with a mean age of 75.4 years; 65% were male. The baseline LAA ostium diameters on TEE were 24.7 ± 5.1 × 18.6 ± 3.3 mm and on CCTA 32.0 ± 7.1 mm × 23.6 ± 5.4 mm. The PDL size was 2.7 ± 2.3 mm by TEE, and the maximum and minimum diameters were 4.9 ± 1.8 mm × 4.0 ± 1.8 mm by CCTA. PDL closure procedural success was achieved in 19 patients (83%). Residual leaks of 0.6 ± 0.6 mm were observed in 9 patients (47%) intraprocedurally. Three patients (13%) developed pericardial effusion, none of whom required additional medical or procedural intervention. Conclusions This study demonstrates that CCTA provides larger and more detailed measurements throughout the procedural stages of PDL closure. Percutaneous closure of PDLs was feasible with minor complications. Larger, prospective studies are essential to establish the role of detailed imaging measurements pre- and post-LAAO, as well as the efficacy and long-term outcomes of PDL closure.
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Zaman et al. (2026) conducted an observational in Peri-device leak after incomplete left atrial appendage occlusion (n=23). Percutaneous peri-device leak closure evaluated with TEE and/or CCTA was evaluated on Procedural success of peri-device leak closure determined intraoperatively with TEE. Percutaneous peri-device leak closure achieved procedural success in 83% of patients (19/23), with CCTA yielding larger LAA ostium and leak measurements than TEE.
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