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

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Abstract

Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation 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 orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics. We included 50 patients who underwent percutaneous LAA occlusion with the Watchman device and had acceptable three-dimensional transesophageal echocardiography images of LAA pre- and post-device placement. We measured offline the LAA orifice 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. Patients were elderly (mean age 76 ± 8 years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1 ± 3.2 vs. post-device 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 cm2, 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 significant 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). LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.

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The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

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Authors and Affiliations

  1. Laboratory of Echocardiography, Yale New Haven Hospital, Cardiovascular Division, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA

    Xochitl A. Ortiz-Leon, Edith L. Posada-Martinez, Alda Bregasi, Wanwen Chen, Ian Crandall, Jason Pereira, Kamil F. Faridi, Joseph G. Akar, Ben A. Lin, Robert L. McNamara, James V. Freeman, Jeptha Curtis & Lissa Sugeng

  2. Laboratory of Echocardiography, National Institute of Cardiology, Juan Badiano 1, Belisario Domínguez Secc. 16, 14080, Mexico City, Mexico

    Xochitl A. Ortiz-Leon, Edith L. Posada-Martinez & Jose A. Arias-Godinez

  3. Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 322, Los Angeles, CA, 90033, USA

    Alda Bregasi & Ben A. Lin

Authors
  1. Xochitl A. Ortiz-Leon
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  2. Edith L. Posada-Martinez
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  3. Alda Bregasi
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  4. Wanwen Chen
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Contributions

Conceptualization: LS. Methodology: ELP-M, AB, WC, IC, JP, JGA, BAL MD, JVF, JC and XAO-L. Formal analysis and investigation: ELP-M and XAO-L; Writing—original draft preparation: XO; Writing—review and editing: KFF and LS. Supervision: RLM, JAA-G and LS.

Corresponding author

Correspondence to Lissa Sugeng.

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Conflict of interest

Dr. Sugeng has received a research grant from and is a speakers’ bureau member for Canon Medical; has received a research grant from and is a speakers’ bureau and advisory board member for Siemens Healthineers; has received a research grant from and is an advisory board member for Philips Healthcare; and has received an equipment grant from and is a speakers’ bureau member for Hitachi. The other authors reported no conflicts of interest.

Ethical approval

The study was approved by the Yale University Institutional Review Board.

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Consent was not required due to retrospective analysis of anonymized information and ultrasound images and the submission does not include images that may identify the patients.

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Ortiz-Leon, X.A., Posada-Martinez, E.L., Bregasi, A. et al. Changes in left atrial appendage orifice following percutaneous left atrial appendage closure using three-dimensional echocardiography. Int J Cardiovasc Imaging 38, 1361–1369 (2022). https://doi.org/10.1007/s10554-022-02525-y

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