Device Selection
Selection of the device to close the residual LA-LAA communication was
dependent on the anatomy in each case, with specific emphasis on the
available depth beyond the persistent communication and the residual
appendage orifice area. With regards to WATCHMAN implantation,
sufficient depth is necessary to accommodate the umbrella-like device
and the orifice must be large enough to accommodate the delivery sheath(Figure 1). Of the five patients, two patients underwent
WATCHMAN implantation (both with prior surgical LAA ligation, Table 2).
In the other three cases, two of whom had a prior surgical ligation, an
Amplatzer occluder device was used (Figure 2, Table 2 ) with the
size and type of device chosen based on TEE assessment of the gap and
the “waist” of the device. In the final patient, an Amplatzer occluder
was chosen to fill the residual gap next to an existing WATCHMAN
(Figure 3, Table 2 ). In this patient, the gap around the
WATCHMAN was complex, and was reproduced using a 3D printed model. The
narrowest neck of the gap appeared to be approximately 8 mm, and the
model allowed physical testing of feasibility of closure and selection
of the optimal device (Figure 3B and C ).