Author + information
- Received November 11, 2016
- Accepted November 30, 2016
- Published online February 20, 2017.
- Ignacio Cruz-Gonzalez, MD, PhDa,
- Jose Carlos Moreno-Samos, MDa,∗ (, )
- Javier Rodriguez-Collado, MDa,
- Yingxian Mob,
- Yat-Yin Lam, MDc,d and
- Pedro Luis Sanchez, MD, PhDa
- aUniversity Hospital of Salamanca, Salamanca, Spain
- bLifetech Scientific Corporation
- cCharité University Medicine, Berlin, Germany
- dCentre Medical, Hong Kong, China
- ↵∗Address for correspondence:
Dr. Jose Carlos Moreno-Samos, University Hospital of Salamanca, Cardiology Department, Paseo San Vicente 58, Salamanca 37007, Spain.
A 72-year-old-woman with nonvalvular atrial fibrillation under oral anticoagulant treatment with direct inhibitor of factor Xa was admitted due to a stroke. It was decided to perform a percutaneous closure of the left atrial appendage (LAA) to prevent further episodes.
Transesophageal echocardiography and cardiac computed tomography scanning were performed showing a chicken wing LAA with a large ostium.
A 34/28-mm LAmbre (Lifetech Scientific, Shenzhen, China) device was selected. Under transesophageal echocardiography and fluoroscopic guidance (Figures 1 and 2), the sheath was positioned at the LAA ostium, then the umbrella was pushed into the distal part by active roll-in activity and finally, the sheath was withdrawn to release the cover, obtaining a complete sealing without any complication (Online Videos 1, 2, 3, 4, and 5).
Percutaneous closure of the LAA can be challenging in selected cases as in chicken wing morphology, in LAA with several lobes, or in LAA with a large difference between the ostium and the body of the appendage.
The LAmbre device (1) recently obtained the Conformité Européenne mark, it is a self-expanded nitinol and polyester device composed of 2 parts: umbrella and cover. The umbrella has 8 small distal hooks that engage into LAA walls and 8 U-shaped ends that are trapped in LAA trabeculations. The umbrella and the cover are connected with a short central waist that acts as an articulating, compliant connection between both, allowing the cover to self-orient to the atrium wall.
This new device is highly adaptable to different LAA morphologies, and it can be very useful in difficult anatomies. The combination of distal hooks and the U-shaped ends and the central waist design may help to achieve complete sealing and to prevent embolization in complex cases.
To the best of our knowledge this is first reported case of LAA occlusion with the LAmbre device.
For supplemental videos and their legends, please see the online version of this article.
Dr. Lam is the clinical proctor for LAmbre left atrial appendage occluder. Yingxian Mo is a clinical specialist for Lifetech Scientific Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 11, 2016.
- Accepted November 30, 2016.
- American College of Cardiology Foundation