case_images: PMC10772948_01
case_images: Pre-procedural CCTA of patient's LAA: (A) CCTA three-dimensional reconstruction image showing a giant LAA (white arrow); (B) measurements of the LAA at the level of the ostium, with diameters measuring 44mm x 32 mm; (C) CCTA revealed the presence of a thrombus in the LAA (corresponding to the arrow); (D) ostium maximum diameter: 44 mm; (E) landing zone diameter: 34 mm. CCTA, cardiac computed tomography angiography; LAA, left atrial appendage.
case_images: ytad629f1.jpg
case_images: PMC10772948_01_ytad629f1.jpg
case_images: ytad629-F1
case_images: Pre-procedural CCTA, performed in November 2022, revealed a giant windsock LAA (Figure 1): at the level of the ostium, measurement of the LAA was 44 mm (maximum diameter) and 32 mm (minimum diameter), with a landing zone diameter of 34 mm, along with a maximal length of 49 mm. Cardiac computed tomography angiography revealed the presence of a thrombus in the LAA (Figure 1C), and patient was treated with low-dose heparin.
case_images: Characteristics of custom-made LAmbre  device, specifically fitted with patient's LAA anatomy. LAA, left atrial appendage.
case_images: ytad629f2.jpg
case_images: PMC10772948_01_ytad629f2.jpg
case_images: ytad629-F2
case_images: In accordance with the manufacturer, leveraging a three-dimension CCTA reconstruction of patient's LAA, a custom-made LAmbre  Closure System (Lifetech Scientific, Shenzhen, China) 38/46 mm (lobe/disc), specifically fitted with patient's LAA anatomy was designed (Figure 2).
case_images: Periprocedural TEE images: (A) pre-procedural TEE image at 50 . (B) Post-procedural TEE at 0  showing the appropriate position of LAmbre  38/46 mm. (C) Three-dimensional TEE at 45  showing the disk of the device covering the entrance of LAA. LAA, left atrial appendage; TEE, transoesophageal echocardiography.
case_images: ytad629f3.jpg
case_images: PMC10772948_01_ytad629f3.jpg
case_images: ytad629-F3
case_images: Through right femoral venous access, transseptal puncture was performed and a 10 F delivery sheath was used to advance the LAmbre  device 38/46 mm, which was successfully deployed under TEE (Figure 3) and fluoroscopic guidance (Figure 4). TEE confirmed the appropriate position of the device and the absence of peri-device leaks (Figure 3). Two days after the procedure, weighing the patient's individual risk for bleeding and thromboembolism, patient was discharged on dual antiplatelet therapy (aspirin plus clopidogrel) for 1 month, followed by clopidogrel up to 6 months.
case_images: Intraprocedural fluoroscopic images of LAAO procedure: (A) contrast injection into LAA. (B) Custom-made LAmbre  device release. LAA, left atrial appendage; LAAO, left atrial appendage occlusion.
case_images: ytad629f4.jpg
case_images: PMC10772948_01_ytad629f4.jpg
case_images: ytad629-F4
case_images: Through right femoral venous access, transseptal puncture was performed and a 10 F delivery sheath was used to advance the LAmbre  device 38/46 mm, which was successfully deployed under TEE (Figure 3) and fluoroscopic guidance (Figure 4).