Changes in Left Atrial Appendage Dimensions Following Volume Loading During Percutaneous Left Atrial Appendage Closure

Abstract

Intraprocedural volume loading with saline increased the LAA orifice and depth dimensions during LAA closure. Operators should consider optimizing the left atrial pressure with volume loading before final device sizing.

Prospective, randomized comparison of 3‐dimensional computed tomography guidance versus TEE data for left atrial appendage occlusion (PRO3DLAAO)

“…The challenges of using TEE for procedural planning mirrors the similar experience seen in 2D‐TEE sizing for the aortic annulus, where the varied anatomy of the appendage cannot be fully understood by multiple single plane interrogations but with volumetric data (Figure ). Variable loading conditions, appendage contractile cycle, and individualized anatomy all play a role in making 2D LAA measurements inaccurate and can be overcome with CT . Similar to our preliminary study, CT LAA widest measurement exceeded 2D‐TEE measurements by a mean of 1.83 ± 0.9 and 2.6 ± 2.3 mm in the CT and 2D‐TEE cohorts respectively and 2.2 ± 1.8 mm for the entire cohort which is comparable to the results from our pilot study (2.7 ± 2.2 mm) .…”

Comparing Measurements of CT Angiography, TEE, and Fluoroscopy of the Left Atrial Appendage for Percutaneous Closure

“…In addition, TEE values were often obtained at a fasting state, and patients may not be adequately volume loaded prior to obtaining measurements. We previously showed that giving 500–1,000 cc saline loading and ensuring left atrial pressure >12 mmHg increased mean LAA dimension by ∼2 mm . Thus, LAA dimensions are sensitive to volume status, which should be optimized before choosing device size accordingly.…”

Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples

“…Besides, LAA is more compliant than the LA main chamber and plays an important role in the presence of LA pressure and/or volume overload [26,27]. The separation between LAA and LA after complete endothelialization of the device results in the disappearance of this LAA reservoir function [14].…”