Changes in left atrial appendage orifice following percutaneous left atrial appendage closure using three-dimensional echocardiography

Abstract

Purpose: Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial brillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA ori ce and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics.Methods: We included 50 consecutive patients who underwent percutaneous LAA occlusion with the Watchman device. Three-dimensional images of LAA pre-and post-device placement were analyzed o ine. We measured the LAA ori ce diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre-and post-procedure were also measured.Results: Patients were elderly (mean age 76±8 years years), 30 (60%) were men. There was a signi cant increase of all LAA ori ce dimensions following LAA occlusion: diameter 1 (pre-device 18.1±3.2 vs. postdevice 21.5±3.4 mm, p<0.001), diameter 2 (20.6±3.9 vs. 22.1±3.6 mm, p<0.001), minimum diameter (17.6±3.1 vs. 21.3±3.4 mm, p<0.001), maximum diameter (21.5±3.9 vs. 22.4±3.6 mm, p=0.022), circumference (63.6±10.7 vs. 69.6±10.5 mm, p<0.001), and area (3.1±1.1 vs. 3.9±1.2 cm 2 , p<0.001).Eccentricity index decreased after procedure (1.23±0.16 vs. 1.06±0.06, p<0.001). LUPV peak S and D velocities did not show a signi cant difference (0.29±0.15 vs. 0.30±0.14 cm/s, p=0.637; and 0.47±0.19 vs. 0.48±0.20 cm/s, p=0.549; respectively). Conclusion: LAA ori ce stretches signi cantly and it becomes more circular following LAA occlusion without causing a signi cant impact on the LUPV hemodynamics.

Long‐term safety and efficacy of left atrial appendage closure in patients with small appendage orifices measured with transesophageal echocardiography

“…Second, the LAA is a very flexible structure. A recent investigation showed that the diameter of the LAA increases by 2 mm after implantation with the Watchman device and the LAA orifice changes from an oval to a more circular shape 20 . Another study found that the compression rate was smaller during follow‐up than during the procedure 21 .…”

“…A recent investigation showed that the diameter of the LAA increases by 2 mm after implantation with the Watchman device and the LAA orifice changes from an oval to a more circular shape. 20 Another study found that the compression rate was smaller during follow-up than during the procedure. 21 The above studies suggested that the LAA adapts to the shape of the occluder after implantation.…”