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Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis

Authors
 Hyemoon Chung  ;  Byunghwan Jeon  ;  Hyuk-Jae Chang  ;  Dongjin Han  ;  Hackjoon Shim  ;  In Jeong Cho  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Jung-Sun Kim  ;  Yangsoo Jang  ;  Namsik Chung 
Citation
 Journal of Cardiovascular Ultrasound, Vol.23(4) : 211-218, 2015 
Journal Title
 Journal of Cardiovascular Ultrasound 
ISSN
 1975-4612 
Issue Date
2015
Keywords
Cardiac CT ; Left atrial appendage ; Occlusion ; Peri-device leakage
Abstract
BACKGROUND: After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. METHODS: We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. RESULTS: Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm(3) vs. 17.8 mm(3), p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). CONCLUSION: Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.
Files in This Item:
T201505808.pdf Download
DOI
10.4250/jcu.2015.23.4.211
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Chung, Hye Moon(정혜문)
Cho, In Jeong(조인정)
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/157176
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