The Chicken-Wing Morphology: An Anatomical Challenge for Left Atrial Appendage Occlusion

ObjectivesTo describe the particular assessment and closure strategy that was followed in patients with left atrial appendages (LAA) with an early and severe bend. BackgroundThe presence of a chicken-wing morphology with an early and severe bend constitutes one of the most difficult anatomical settings for transcatheter LAA occlusion. MethodsBetween November 2009 and December 2012, patients who presented chicken-wing LAA with an early (<20mm from the ostium) and severe bend (<180 degrees) were identified and included in the analysis. A particular implanting strategy consisting of deploying the distal lobe of the device inside the chicken-wing bend was used in all cases. ResultsAmong 42 patients who underwent LAA occlusion during the study period, 5 (12%) presented the pre-specified anatomy. Following the mentioned implanting strategy, all patients underwent successful LAA occlusion using the Amplatzer Cardiac Plug (n=2) and the Amplatzer Amulet (n=3). Successful occlusion was achieved in all patients. None of them presented any procedural complication. Follow-up transesophageal echocardiography at 3 months showed successful LAA sealing in all patients and no device embolization or thrombosis. ConclusionsAccording to our results, the pre-specified closing implantation technique for chicken-wing LAAs with an early and severe bend might be a valid strategy for this challenging anatomical setting. Further cases will be necessary to confirm the results. (J Interven Cardiol 2013;26:509-514)