chiusura percutanea auricola sn 2015 case report
TRANSCRIPT
Alberto Maria Lanzone
Istituto Clinico HUMANITAS Gavazzeni
Bergamo
AMPLATZER™ AMULET
The AMPLATZER™ Cardiac Plug or AMULET are percutaneous transcatheter devices intended for cardiac structures not involving the septal wall, which require closure or occlusion. One intended use is the nonsurgical closure of the left atrial appendage.
Patient selection, imaging and device selection is critical for the successful implantation of the ACP.
The AMPLATZER™ AMULET is contraindicated for the following:
Patients with the presence of intracardiacthrombus.
Patients with active endocarditis or other infections producing bacteremia.
Patients where placement of the device would interfere with any intracardiac or intravascular structures. (mitral valve, circumflex artery, etc.)
MV
LSPV
LIPV
LAA
LSPV
LIPVRIPV
RSPV
RIPV
LS
LI
RSPV
A B
C D
LSPV
LIPV
LAA
Mitral valve
superior wall
poste
rior
wall
an
terio
r w
all
23% of hearts
Left Atrial Appendage Measurements
Veinot, John; Harrity, Phillip; Gentile, Federico; Khandheria, Bijoy; Bailey, Kent; Eickholt, Jeffrey; Seward, James; Tajik, A; Edwards, William. Circulation. 96(9):3112-3115, November 4, 1997.
Anatomy of the Normal Left Atrial Appendage: A Quantitative Study of Age-Related Changes in 500 Autopsy Hearts: Implications for Echocardiographic Examination.
Diameter: 1,11± 0,33Width: 1,70 ± 0,60Length: 2,56 ± 0,72
The appendages had 2–5 branches and 0–12 twigs
The mean angle of the first bend was 134°
The morphological appearanceof the LAA could be classified into two types: slender like a crooked finger (81.8%)and stump-like (18.2%).
The principal axis was: -tortuosus and spiraled in 42% of hearts, - extremely bent and slightly spiraled in 24%, - slightly bent and extremely spiraled in 5% -and slighly bent and spiraled in 23%
P Su, K P McCarthy, S Y Ho Heart 2008;94:1166–1170.
Mitral Valve
Pectinate Muscles
VI
Frontal Section(four chamber)
INTERNAL MORPHOLOGY
PectinateMuscles areinside
But ………..not only
Circunflexartery
MajorCardiacvein
Extra-appendicularPectinate Muscle
Extra-appendicularPectinate Muscle
Extra-appendicularPectinate Muscle
CircunflexArtery
Major CoronaryVein
MitralValve
Coronary sinus
orifice
LeftAtrium
Left Superior Pulmonary Vein
ICV
FrontalSection (four chambers)
Cortesy of:
Profesor Damián Sánchez Quintana
Dpto. de AnatomiaHumana
Facultad deMedicina
Universidad Extremadura
CircunflexArtery
Major CoronaryVein
MitralValve
Coronary sinus
orifice
LeftAtrium
Left Superior Pulmonary Vein
ICV
Extra-appendicularPectinate Muscle
Potentially, the left superior
pulmonary vein, mitral valve
and anterior descending CA
can be at risk during
occlusion of the LAA.