case_images: PMC10768971_01
case_images: Unfavourable position of the delivery sheath, due to high and posterior puncture, pointing towards the roof of the LAA overcomes with steerable delivery sheath. (A) 3D TEE evaluation of the direction of the delivery sheath that was not aligned with the main axis of the appendage. (B) Unfavourable direction of delivery sheath and anatomy of the LAA due to a sharp band directed downward. (C) LAA coaxial alignment achieved deflecting the distal curve of steerable delivery towards the main direction of the appendage. (D) Deployment of device lobe in the correct position. (E, F) TEE view of landing zone and LAA morphology. (G) After Amulet 22 release, we performed TEE with demonstration of optimal device compression and concave shape of the disc, sealing the LAA. (H) Fluoroscopic view confirmation of good procedural result.
case_images: ytad592f1.jpg
case_images: PMC10768971_01_ytad592f1.jpg
case_images: ytad592-F1
case_images: Then we performed the LAAO procedure by advancing a pigtail marker catheter into the LAA for selective injection in two projections (Figure 1). Then we deployed the 22 Amplatzer Amulet (Abbott, IL, USA) (Figure 1) achieving an optimal positioning with a single attempt.
case_images: Transoesophageal guided transcatheter mitral valve edge-to-edge repair. (A) TEE baseline assessment of mitral regurgitation. (B) Post-procedural TEE evaluation of TEER optimal result.
case_images: ytad592f2.jpg
case_images: PMC10768971_01_ytad592f2.jpg
case_images: ytad592-F2
case_images: Amsterdam, Netherlands). After transseptal puncture (TSP), we achieved a correct positioning of the MitraClip G4 XTW (Abbott, IL, USA), and we grasped the leaflets, assessed a major reduction of MR, and released the clip (Figure 2).