Author + information
- Received November 12, 2010
- Accepted November 25, 2010
- Published online September 13, 2011.
A 65-year-old man was referred for routine left atrial appendage (LAA) device closure (Watchman, Atritech, Inc., Plymouth, Minnesota). The patient had a history of atrial fibrillation, with a CHADS2 score of 2, warranting warfarin anticoagulation therapy. The patient was reluctant to continue on warfarin because he worked with machinery and often sustained minor injuries when operating equipment.
The patient was referred for Watchman insertion under general anesthesia. Periprocedural 2-dimensional transesophageal echocardiography (TEE) showed a single-lobe LAA with no evidence of LAA thrombus. After TEE-guided transseptal puncture, a 27-mm device was successfully deployed into the LAA, and 2-dimensional TEE showed excellent device compression (A). After 2 stability “tug tests,” both fluoroscopy and TEE confirmed that the device was well seated. However, 3-dimensional TEE clearly showed a large posterior gap measuring 1.3 cm (B, Online Video 1). The Watchman device was subsequently recaptured and the LAA deemed unsuitable for device closure. Ao = aorta; LUPV = left upper pulmonary vein.
- Received November 12, 2010.
- Accepted November 25, 2010.
- American College of Cardiology Foundation