Fig 1.
CONSORT flow chart.
Fig 2.
Overview of integrated echocardiography and fluoroscopy imaging.
The image acquisition angles during transseptal puncture are depicted in the lower right corner of each image. A+B) Concordant views of TEE and fluoroscopy images. C) In the “Free view” echocardiographic images can be rotated and zoomed independently from the echocardiographer by using a tableside control. D) Conventional echocardiographic view using the x-plane mode for identification of the preferred transseptal puncture site (Septum, blue). Sheath with transseptal needle; Pigtail cath. = pigtail catheter; RV cath. = catheter in the right ventricle.
Fig 3.
Visualization of the LAA and surrounding structures preceding occluder positioning.
The LAA orifice (red), the crista (yellow), and the septum (blue) are marked by landmark setting. A) 2D-TEE image in the same anatomical alignment as the C-arm. B) Outlines of 2D-TEE (pink lines) are fused with the fluoroscopy image. C+D) 2D-TEE with anatomical landmarks depicted in different angles. Note the sheath in close proximity to the left superior pulmonary vein as supported by the matching landmarks in different views. RV cath. = catheter in the right ventricle.
Fig 4.
Evaluation of adequate device position and stability by using 3D-TEE and fluoroscopy.
After LAA occluder release correct positioning is verified simultaneously by rotation and zoom of the 3D-TEE image and angiography. The LAA occluder is shown in the 3D-TEE “Free view” (A) by using the tableside control and the fluoroscopy (B) demonstrating the relationship to surrounding structures (LCX, crista). Note the relatively large crista which could not be fully covered by the disc of the LAA occluder, while contrast agent injection demonstrated good LAA sealing.
Table 1.
ACE: angiotensin converting enzyme; AF: atrial fibrillation; INR: international normalized ratio; PCI: percutaneous coronary intervention; SD: standard deviation.
Table 2.
Procedural data.