case_images: PMC9301371_01
case_images: After LAAC, the occluder fell off into the aortic arch and was feathered out, before the 33-mm Watchman device was occluded again. (A,I,J) LA TEE images. (A) Preoperative LAA: ostial of 25-30 mm and an effective depth of 28 mm. (I,J) Two-dimensional and 3-dimensional images after the second closure with the Watchman device. (B,C,E,F,H) DSA images. (B) Preoperative LAA with an opening of 28 mm and a depth of 31 mm. (C) After occlusion with the 33-mm Watchman device. (E,F) Endoscopic Raptor forceps were used to clamp the umbrella trabeculae and drag it into the sheath. (H) Second closure with the Watchman device. (D,K) Chest CT image. (D) Occluder in the aortic arch. (K) LAAC with the Watchman device. (G) Modified occluder.
case_images: fcvm-09-905344-g001.jpg
case_images: PMC9301371_01_fcvm-09-905344-g001.jpg
case_images: F1
case_images: Transesophageal echocardiography (TEE) measured an LAA ostial of 25-30 mm and an effective depth of 28 mm (Figure 1A). Digital subtraction angiography (DSA) measured the LAA opening as 28 mm and the depth as 31 mm (Figure 1B). Bedside echocardiography did not show the LAA occluder, and a chest CT scan revealed that the occluder was in the aortic arch (Figure 1D). Watchman occluder was removed (Figure 1G). When the vascular sheath was withdrawn, the femoral artery was sutured with ProGlide at the puncture site of the femoral artery. TEE confirmed that the Watchman device was properly positioned (Figures 1H-J). Six months later, a chest CT showed that the LAA occluder was in a good position (Figure 1K).
case_images: PMC9301371_02
case_images: After LAAC, the occluder detached into the LA and was retrieved, before the Lacbes 2834 device was occluded again. (A,B,I) TEE images. (A) Preoperatively, the diameter of the LAA opening was 18.3-22 mm and the diameter of the anchoring area was 16.5-24.4 mm. (B) The Lacbes 2834 was placed in LAA, the fixed column was exposed, and the residual shunt at the upper edge was 4.3 mm. (I) After the second LAAC procedure with Lacbes 2636, the covering disc adhered well and had no residual shunt. (C-H,J) DSA images. (C) Preoperatively, the diameter of the LAA change opening was 28.56 mm and the diameter of the anchoring area was approximately 31.47 mm. (D) After closure with the Lacbes 2834 device. (E) The Lacbes fell into the LA. (F-H) Endoscopic Raptor forceps were used to clamp the umbrella trabeculae and drag them into the sheath. (J) After the second LAAC procedure with the Lacbes 2636 device.
case_images: fcvm-09-905344-g002.jpg
case_images: PMC9301371_02_fcvm-09-905344-g002.jpg
case_images: F2
case_images: TEE was 18.3-22 mm and the anchoring zone was 16.5-24.4 mm (Figure 2A). The LAA showed a chicken wing shape. The diameter of the opening of the LAA as measured by DSA was 28.6 mm, and the anchoring area was 31.5 mm (Figure 2C). A Lacbes 2834 device was delivered (Figure 2D). The occluder was slowly released after pulling it steadily (Figure 2B). Under DSA, the occluder was seen floating in the LA (Figure 2E). Once the disc was grasped, sustained traction initially dislodged the proximal disc from the LA, and the occluder was pulled back to the sheath (Figures 2F-H); then, the Lacbes 2636 device was placed in the LAA (Figures 2I,J).