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Computed tomography measurement for left atrial appendage closure

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Abstract

Percutaneous left atrial appendage closure (LAAC) has been reported many therapeutic effects with regard to its safety and efficacy, and the number of patients with non-valvular atrial fibrillation undergoing LAAC is increasing worldwide. Although it is a highly safe procedure, further improvements are expected and preoperative planning is extremely important. For this purpose, transesophageal echocardiography has been mainly performed so far, however, nowadays, it is recommended to determine a more optimal treatment strategy combined with computed tomography. Preoperative CT predicts not only the risk of the intervention based on anatomical features of the left atrial appendage (LAA) but also the device type and size, sheath type, optimal location for septal puncture and pre-procedurally clarifies the left atrium and LAA dimensions. Furthermore, postoperative CT can evaluate device-related thrombus and peri-device leak, making it possible to observe the postoperative course using less invasive methods. This study reviews the practical utility of CT in pre- and post-LAAC.

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Abbreviations

AF:

Atrial fibrillation

ECG:

Electrocardiogram

MSCT:

Multi-slice computed tomography

DOAC:

Direct oral anticoagulant

DRT:

Device-related thrombus

HU:

Hounsfield unit

LA:

Left atrium

LAA:

Left atrial appendage

LAAC:

Left atrial appendage closure

LCx:

Left circumflex coronary artery

MPR:

Multiplanar reconstruction

OAC:

Oral anticoagulant

PDL:

Peri-device leak

TEE:

Transesophageal echocardiography

VR:

Volume rendering

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Acknowledgements

The author thanks Naoki Hosoda for his valuable contributions for providing excellent figures.

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This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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  1. Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo, 101-8643, Japan

    Masahiko Asami

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Correspondence to Masahiko Asami.

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Dr. Asami is a clinical proctor for Boston Scientific and has received remuneration from Boston Scientific, Abbott Medical, Edwards Lifesciences, Medtronic, Canon Medical Systems, and Ziosoft.

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Asami, M., the OCEAN-SHD Investigators. Computed tomography measurement for left atrial appendage closure. Cardiovasc Interv and Ther 37, 440–449 (2022). https://doi.org/10.1007/s12928-022-00852-4

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