Author + information
- Juan F. Viles-Gonzalez, MD⁎ ( and )
- Vivek Y. Reddy, MD
- ↵⁎Department of Medicine, Cardiovascular Division, Cardiac Electrophysiology Section, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, Florida 33136
We read with interest the letter of Dr. Ren, stating that accurate echocardiographic measurement of the left atrial appendage (LAA) anatomy, especially of the ostium, is critically important for successful LAA ostial closure using the Watchman device. In our study, the Core Echocardiography Laboratory measured the echocardiographic ostium of the LAA, and the LAA body size (1). In addition, he expressed disagreement with the explanation of “shape mismatch,” which consists of an oval-shaped LAA and a spherical LAA closure device. We agree that accurate measurement of maximal LAA ostial diameter is of critical importance to obtain adequate seal of the LAA. We also share the opinion that the LAA ostium is a soft tissue structure that can be expanded and fit completely to the device shape if the device is placed at an optimal location. However, we found in clinical practice and during the study, that even when we chose a device that was slightly larger, because the diameter of the LAA ostium is larger in one of the orthogonal axes (i.e., oval shape), a spherical device may not completely occlude the ostium. The shape mismatch between the LAA ostium and the device is clearly evidenced in the three-dimensional transesophageal echocardiographic images, such as the one included in our paper (1).
- American College of Cardiology Foundation