Abstract：
Peri-device leak after left atrial appendage closure (LAAC) is often treated with endovascular coils, plugs, or second occluders. This is the first study reporting the Amulet device used for peri-device leak. An 80-year-old male with paroxysmal atrial fibrillation and recurrent falls with head trauma who underwent LAAC with a 24 mm Watchman 2.5 device 3 years ago at another institution was referred to our clinic for management of the peri-device leak. Transesophageal echocardiogram showed persistent residual peri-device leak with 5 mm width along the Coumadin ridge aspect of the device. Computed tomography (CT) also showed the peri-device leak with width of 6 mm and complete opacification of left atrial appendage (LAA). Importantly, CT demonstrated that the Watchman 2.5 device was deployed at distal LAA, leaving the proximal part of LAA with length of 10 mm from ostium. Under general anesthesia, a 22 mm Amulet device was deployed successfully with complete sealing of LAA. Procedure planning is the key to minimize the risk of peri-device leak or device-related thrombosis. Careful assessment of LAA anatomy using multimodality images for peri-device leak after LAAC helped optimal treatment strategy including second LAAC with different type of devices.
摘要：
左心耳封堵(LAAC)后的装置周围渗漏常采用血管内弹簧圈治疗,插头,或第二封堵器。这是第一项报告Amulet装置用于装置周围泄漏的研究。一名80岁的男性阵发性心房颤动，并因头部外伤反复跌倒，3年前在另一家机构接受了24毫米Watchman2.5设备的LAAC，被转诊到我们的诊所进行设备周围泄漏的管理。经食管超声心动图显示持续的残余装置周围泄漏，沿装置的Coumadin脊方向有5mm宽。计算机断层扫描（CT）也显示了宽度为6mm的装置周围渗漏，左心耳（LAA）完全混浊。重要的是,CT显示Watchman2.5装置部署在远端左心耳,离开左心耳的近端，距离口10毫米长。在全身麻醉下,一个22毫米的护身符装置已成功部署，左心耳完全密封。手术计划是将器械周围渗漏或器械相关血栓形成风险降至最低的关键。LAAC后，使用多模态图像对LAA解剖结构进行仔细评估，以检查器械周围的泄漏，有助于优化治疗策略，包括使用不同类型的器械的第二LAAC。
