Maiani Silvia, Nardi Giulia, Stolcova Miroslava, Ristalli Francesca, Crociani Maria Federica, Ciardetti Niccolò, Mattesini Alessio, Di Mario Carlo, Meucci Francesco
Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy.
Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Monserrato, Italy.
J Cardiol Cases. 2025 Jan 15;31(4):97-100. doi: 10.1016/j.jccase.2024.12.001. eCollection 2025 Apr.
Left atrial appendage occlusion (LAAO) has as a comparable efficacy and safety profile compared with oral anticoagulation therapy in patients with atrial fibrillation. The procedural success rate is high, but some challenging anatomies may preclude optimal closure with standard devices. Our patient underwent a first LAAO attempt with Amplatzer Amulet 34 mm (St. Jude Medical, Saint Paul, MN, USA) and Watchman FLX 35 mm (Boston Scientific, Marlborough, MA, USA), but device anchoring was not feasible or sub-optimal due to the oversized LAA. The procedure was postponed in order to perform a cardiac computed tomography angiography and a custom-made LAmbre Closure System 42/52 mm (Lifetech Scientific, Shenzhen, China), specifically fitted with patient's LAA anatomy, was successfully implanted. The procedure was straightforward, and the device perfectly adapted to our patient's anatomy, with no residual leak.
Left atrial appendage presents several morphologies and procedural success rate of left atrial appendage occlusion is high, but challenging anatomies may preclude optimal closure with standard devices. Our case emphasizes the importance of pre-procedural planning and the safety and feasibility of custom-made devices, overcoming procedural failure of a previous attempt with standard devices.
在房颤患者中，左心耳封堵术（LAAO）与口服抗凝治疗相比具有相当的疗效和安全性。手术成功率很高，但一些具有挑战性的解剖结构可能无法使用标准器械实现最佳封堵。我们的患者首次尝试使用美国明尼苏达州圣保罗市圣犹达医疗公司生产的34毫米Amplatzer Amulet和美国马萨诸塞州马尔伯勒市波士顿科学公司生产的35毫米Watchman FLX进行左心耳封堵，但由于左心耳过大，器械锚定不可行或效果欠佳。为了进行心脏计算机断层血管造影，手术被推迟，随后成功植入了专门根据患者左心耳解剖结构定制的42/52毫米LAmbre封堵系统（深圳微创医疗科学有限公司）。手术过程顺利，器械与患者的解剖结构完美适配，无残余渗漏。
左心耳呈现多种形态，左心耳封堵术的手术成功率很高，但具有挑战性的解剖结构可能无法使用标准器械实现最佳封堵。我们的病例强调了术前规划的重要性以及定制器械的安全性和可行性，克服了先前使用标准器械手术失败的问题。
