CT imaging for left atrial appendage closure: A review and pictorial essay

Ismail, Tevfik F; Panikker, Sandeep; Markides, Vias; Foran, John P.; Padley, Simon; Rubens, Michael B.; Wong, Tom; Nicol, Edward

doi:10.1016/j.jcct.2015.01.011

Cited by 45 publications

(30 citation statements)

References 18 publications

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“…Cardiac CT is an emerging tool for guidance in percutaneous LAA closure; it allows for complete volumetric evaluation of the LAA and has good spatial orientation relative to important neighboring structures, including the mitral valve and PVs [66,67]. The ostial perimeter of the LAA measured by cardiac CT is the most reproducible parameter for sizing an LAA occluder, rather than the measurement of LAA maximum diameter [68,69].…”

Section: Left Atrial Appendage Morphology and Percutaneous Left Atriamentioning

confidence: 99%

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

Jung

2017

Cardiovasc Imaging Asia

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Section: Left Atrial Appendage Morphology and Percutaneous Left Atriamentioning

confidence: 99%

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

Jung

2017

Cardiovasc Imaging Asia

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“…For the pre‐procedural planning of LAA occlusion device implantation, the morphology of the LAA should be assessed. Various morphological types of the LAA have been described in the literature: windsock, cactus, chicken wing and broccoli . Of these, the broccoli type has a complex morphology, lacking a single dominant lobe.…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

“…This is paramount in determining the correct sizing of the LAA occlusion device. Several types of LAA occlusion device are commercially available, including the Watchman device (Boston Scientific, Marlborough, MA, USA) which is available in a range of diameters (21–33 mm), and the Amplatzer Cardiac Plug (St Jude Medical, St. Paul, MN, USA) which is able to cover LAA ostium diameters ranging from 12.6 to 28.5 mm . Incomplete opacification of the LAA should be reported.…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

“…Because the LAA occlusion device is implanted via a transseptal puncture, abnormalities involving the inter‐atrial septum which may adversely impact on the transseptal puncture (e.g. atrial septal aneurysm, atrial septal defects and excessive lipomatous hypertrophy of the interatrial septum) could also be assessed by MDCT …”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

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Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Gooley

Seneviratne

et al. 2016

J Med Imag Rad Onc

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In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

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“…Because of high variability in LAA morphology and anatomical correlations to NBS, prevention of device‐derived complications confronts clinicians with problems that differ in each case. Described as possible structures especially at risk because of their proximity to the LAA have been the mitral valve annulus (MVA), left pulmonary artery (LPA), left upper pulmonary vein (LUPV) and circumflex artery (Cx) . Furthermore, case reports of occlusion of Cx, perforation of LPA and pulmonary vein compression have been published.…”

Section: Introductionmentioning

confidence: 99%

Relation of left atrial appendage closure devices to topographic neighboring structures using standardized imaging by cardiac computed tomography angiography

Lindner

Behnes

Wenke

et al. 2018

Clinical Cardiology

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Background Although left atrial appendage (LAA) anatomy and topographic relations are well understood, little is known about the impairment of neighboring structures (NBS) by an implanted left atrial appendage closure (LAAC) device. This prospective longitudinal observational study for the first time describes distances of implanted LAA closure (LAAC) devices to NBS using a standardized imaging protocol of cardiac computed tomography angiography (cCTA). Hypothesis cCTA imaging is an eligible tool for post‐implantation evaluation of LAAC devices and their relation to neighboring structures. Methods cCTA data sets of consecutive patients 6 months after successful LAAC were acquired on a third generation dual‐source CT system and reconstructed with a slice thickness of 0.5 mm. The standardized multi‐planar reconstruction LAA occluder view for post‐implantation evaluation (LOVE) algorithm was used to measure the distances to NBS in relation to LAA morphology and implanted LAAC devices. Results A total of 48 patients (median age 80 years, 25% female) were included. Left upper pulmonary vein and circumflex artery were generally closest to occlusion devices (median 2.9 and 2.8 mm, respectively). AMPLATZER AMULET devices were closer to the mitral valve annulus than WATCHMAN devices (6.6 mm (inter quartile range [IQR] 4.9‐8.6) vs 10.9 mm (IQR 7.4‐14.0), P = 0.001). Distances to the left upper pulmonary vein were affected by LAA morphology, with cauliflower type having the closest proximity (1.7 mm [IQR 1.0‐3.4], P = 0.048). Conclusion A standardized cCTA imaging protocol is an eligible tool to accurately measure distances to NBS. Left upper pulmonary vein and circumflex artery are closest to LAAC devices and could thus be most prone to impairment.

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CT imaging for left atrial appendage closure: A review and pictorial essay

Cited by 45 publications

References 18 publications

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Relation of left atrial appendage closure devices to topographic neighboring structures using standardized imaging by cardiac computed tomography angiography

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