Page 12 - Journal of Structural Heart Disease Volume 1, Issue 4

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Meeting Abstracts
nel CPS® cerebral protection device was used. For iLAAO, the Watch- man® device was used in two patients and the Amulet® in three. After iLAAO, the lters underwent histopathological examination.
Results: A total of 10 lters (one proximal and one distal lter for each patient) were collected and underwent histopathological analysis (CV Path Institute Inc.). Debris was found in all patients (9/10 lters). Acute thrombus was found in 3 patients (2 Watchman®; 1 Amulet®), organizing thrombus in 4 patients (1 Watchman®; 3 Amulet®). Two Amulet® patients had endocardial or myocardial tissue in their lters. None of the lters included calci cations or other foreign material. The maximal diameter of the collected material was 0.68 (±0.9) mm.
Conclusion: As expected, iLAAO can cause embolization of thrombot- ic material and other debris, either preexisting (e.g. embolization of echocardiographically undetected LAA thrombus) or induced by the procedure. This nding strongly encourages further investigations of the underlying mechanisms for embolization of di erent types of material, as well as the clinical impact of microemboli. Potential dif- ferences in thrombogenic potential between devices should also be addressed in future investigations. The potential for thrombo- embo- lism should be taken into account for device design and implantation techniques.
ANTICOAGULATION MANAGEMENT AFTER LEFT ATRIAL APPENDAGE CLOSURE WITH THROMBUS FORMATION AND HIGH BLEEDING RISK
Dr. Inés Toranzo-Nieto1, Dr. Victor Exposito1, Dr. Felipe Rodriguez-Entem1, Dr. Susana Gonzalez-Enriquez1, Dr. Rocio Perez-Montes2, Dr. Javier Ruano3, Dr. Ignacio Garcia-Bolao4, Dr. Juanjo Olalla1
1 Hospital Universitario Marques de Valdecilla; Invasive Electrophysiology; Adult cardiology, Santander, Spain
2 Hospital Universitario Marques de Valdecilla; Coagulation Disorders; Haematology, Santander, Spain
3 Hospital Universitario Marques de Valdecilla; Echocardiography; Adult Cardiology, Santander, Spain
4 Clinica Universitaria; Invasive Electrophysiology; Adult Cardiology, Pamplona, Spain
Background: Device associated thrombus formation is a feared com- plication of left atrial appendage closure (LAAO). Anti- coagulation management in this setting remains a challenge, as patients frequent- ly su ered from comorbidities that increase bleeding risk.
History and Indication For Intervention: A 75- year-old male (82 kg) with persistent atrial brillation and past medical history of hyperten- sion, dyslipidemia, chronic renal failure (creatinine clearance 25-30 ml/min, serum creatinine 2.2 mg/dL) and peripheral arterial disease (CHADS-VASc= 5) had to stop oral anticoagulation because of gas- tro-intestinal bleeding under acenocumarol and apixaban (2.5 mg bid). Gastroenterology studies were performed, showing duodenal angiodysplasia and gastric and sigma polyps. Several trials of electro- coagulation along with octreotide treatment were tried unsuccess- fully. Patient experienced several bleeding episodes with secondary iron-de ciency anemia. He underwent several transfusion and treat- ment with endovenous iron and EPO.At the same time, echocardio- gram showed severe left ventricular dysfunction (EF 25-30%) in the context of tachymyo- cardiopathy, despite optimization of antiar- rhythmic and chronotropic drugs.
Due to these problems, oral anticoagulation was discontinued, and pulmonary vein ablation and percutaneous left atrial appendage clo- sure were planned.
Intervention: Pulmonary vein isolation was conducted under gen- eral anesthesia, using a standard point-by-point ablation with irri- gated catheter (Navistar Thermocool, Biosense Webster, CA, USA). LAAO was performed with Watchman device (Atritech, Inc, Plym- outh, Minnesota, MN) implantation, immediately after the ablation procedure. The ablation catheter was removed and the initial sheath was replaced by a 14F transseptal access sheath (Atritech, Inc, Plym- outh, MN), which was positioned in the LAA. The Watchman device access sheath and dilator was advanced over the wire into left atri- um. Size and shape of the LAA was determined by using monoplane uoroscopy (with pigtail catheter and additional angiograms, RAO 30o) and 3-dimensional TEE guidance. LAA ostium diameter varied between 19-23 mm in di erent angles (from 0o to 135o), and LAA depth was 26 mm. Under uoroscopy guidance, delivery catheter was advanced into the access sheath until the most distal marker band, and deployed as per manufacturer’s recommendations. Release cri- teria (position, anchor, size and seal) were met, and Watchman de- vice (no 30) properly placed, stable during tug test, without any leak, and high compression.
A COMPARISON OF 2-D AND 3-D ECHOCARDIOGRAPHY IMAGING DURING PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE (LAAO)
Katarzyna Mitrega, Witold Streb, Magdalena Szymala, Tomasz Podolecki, Zbigniew Kalarus
Department of Cardiology, Congenital Heart Diseases, and Electrotherapy Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
Background: To chose an appropriate occluder size for left atrial ap- pendage occlusion (LAAO), accurate assessment of the ostium and landing zone dimensions is essential. To date, the utility of 3-D versus 2-D has not been examined.
Objective: The aim of this study was to compare 2-D and 3–D echo- cardiography imaging performed during LAAO by two independent echocardiographers and to assess reproducibility of either method.
Methods: We analyzed 33 consecutive patients who underwent LAAO in our clinic. During LAAO the patients were anesthetized and the TEE was performed. Two independent echocardiographers measured LAA ostium and landing zone via 2-D and 3-D TEE.
Results: Mean values of ostial diameters measured in 2-D TEE by two independent echocardiographers were 23.8±4.4 vs 25.2±5.4 (P=0.04) and mean landing zone diameters were 18.3±4.4 vs 19.9±4.0 (P=0.005). In 3-D TEE mean ostial diameter was 29.5±5.3 vs 30.4±6.5 (P=0.07) and the landing zone 21.9±3.8 vs 22.2±3.9 (P=0.23). When the 2-D and 3-D measurements were compared, the ostial and landing zone diameters di ered signi cantly (P<0.0001 and P<0.001 respectively).
Conclusions: There are signi cant di erences between 2-D and 3-D TEE measurements of the ostial and landing zone diameters. 3-D mea- surements may be more reproducible than 2-D measurements.
CSI Africa 2015 Meeting Abstracts