Percutaneous Closure of Incomplete Surgical Left Atrial Appendage Ligation: Success Begins With the Decision to Try

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00084. Epub April 25, 2024.

The authors present a case of percutaneous closure of an incomplete surgical left atrial appendage (LAA) ligation with a new device LAmbre (Lifetech ScientificCo Ltd).

A 79-year-old male (CHA₂DS₂-VASc = 4, HAS-BLED = 3) with a medical history of atrial fibrillation, dual-chamber pacemaker insertion, coronary artery bypass grafting, biological mitral prosthesis, and surgical LAA ligation in 2021. He was referred for LAA closure due to recurrent major intestinal bleeding with anticoagulation therapy. A transesophageal echocardiogram (TEE) evaluation revealed that the LAA was partially ligated with a residual flow inside (Figure 1A). Computed tomography was performed, which showed a cactus-type LAA with a very narrow ostium (9 x 11 mm) and a wide landing zone (Video 1). The distance to mitral biological prosthesis was 19 mm (Figure 1B and C). A 3D LAA model was made to verify the optimal strategy for this case (Figure 1D), and an inferior and posterior transeptal puncture site was performed (Figure 2A).

The key step of the implantation was to forward the 10-French delivery sheath with a double distal curve of 45 by 30 degrees over the neck (Figure 2B). A 26-mm anchoring umbrella was expanded in the LAA and a 32-mm cover disc was deployed, sealing the ostium (Figure 2C, Video 2). After confirming the distance to the mitral prosthesis and pulmonary vein by TEE (Figure 2D, Video 3), the device was successfully released.

The present case demonstrates that LAmbre device could be a good option for successful closure in this shallow post-surgical anatomy. Multimodal image planning was crucial to successfully resolve this challenging case.

Affiliations and Disclosures

From the University Hospital Ramon y Cajal, Madrid, Spain.

Consent statement: The authors confirm that informed consent was obtained from the patient for the described procedure and publication thereof.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Luisa Salido-Tahoces, MD, PhD, Cardiology Department, University Hospital Ramon y Cajal, Carretera de Colmenar Km 9100, Madrid 28034, Spain. Email address: luisasalido@gmail.com; X: @luisasalido