Abstract
We present a case of percutaneous left atrial appendage closure in awake non intubated patient, in which Intraprocedural ultrasound images were obtained with a micro transesophageal echocardiographic probe (MTEE) and intracardiac echocardiography (ICE) together with angiography.
Transcatheter left atrial appendage closure in atrial fibrillation is a feasible option with proven results in preventing thromboembolic events . The procedure is usually performed under general anesthesia with mechanical ventilation and intraprocedural ultrasound images are routinely obtained by standard transesophageal probe (TEE). In some patients, general anesthesia and intubation may be at high risk or contraindicated due to frailty or comorbidities (for example elderly patients with chronic pulmonic disease), and standard TEE probe may be not tolerated with just light sedation.
A 70 year old female patient, with a recent history of cerebral haemorragic stroke and atrial fibrillation transcatheter ablation was treated with percutaneous left atrial appendage closure in our center. Patient was lightly sedated before procedure. Two femoral venous vascular accesses were obtained in both right and left groin. Intraprocedural ultrasound images were obtained with a micro transesophageal echocardiographic probe (MTEE) (S8-3 t sector array multiplane microTEE, Royal Philips Electronics, Amsterdam, The Netherlands) ( Fig. 1 B , § on Fig. 1 D) and intracardiac echocardiography (ICE) (Acuson AcuNav 8 F Diagnostic Ultrasound Catheter, Siemens Medical Solution, CA, USA) ( Fig. 1 C, * on Fig. 1 D), together with angiography ( Fig. 1 A). Both MTEE and ICE gave adequate images for atrial transeptal puncture. The obtained left appendage ostium measurements were compared between MTEE (15,1 mm), ICE ( 16,2 mm) and angiography (15,3 mm) with comparable results. A 22 mm Amplatzer Cardiac Plug (AGA Medical Corporation, MN, USA) (# on Fig. 1 D) was successfully implanted without complications. While ICE was more useful approaching LAA with the delivery catheter, MTEE was more adequate verifying the correct placement of the plug. A final angiogram confirmed the correct placement of the device. Patient was discharged the day after the procedure.
