Related Experiment Video
Updated: Oct 5, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Changes in left atrial appendage orifice following percutaneous left atrial appendage closure using three-dimensional
Xochitl A Ortiz-Leon1,2, Edith L Posada-Martinez1,2, Alda Bregasi1,3
1Laboratory of Echocardiography, Yale New Haven Hospital, Cardiovascular Division, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
Insights
Percutaneous left atrial appendage (LAA) occlusion using the Watchman device significantly increases LAA orifice size and circularity. This procedure does not negatively impact the hemodynamics of the adjacent left upper pulmonary vein (LUPV).
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Percutaneous left atrial appendage (LAA) occlusion is a growing alternative for patients with atrial fibrillation who cannot tolerate long-term anticoagulation.
- Understanding the procedural effects on LAA geometry and adjacent structures is crucial for patient management.
Purpose of the Study:
- To evaluate the impact of Watchman device-based LAA occlusion on LAA orifice geometry.
- To assess the subsequent effects on the hemodynamics of the adjacent left upper pulmonary vein (LUPV).
Main Methods:
- Retrospective analysis of 50 patients undergoing Watchman LAA occlusion.
- Three-dimensional transesophageal echocardiography was used for pre- and post-procedure LAA orifice measurements.
- Measurements included LAA orifice dimensions, circumference, area, and eccentricity index; LUPV flow velocities were also assessed.
Main Results:
- Significant increases in LAA orifice diameter, circumference, and area were observed post-occlusion.
- The LAA orifice became more circular, indicated by a decreased eccentricity index.
- No significant changes in LUPV peak S and D velocities were detected post-procedure.
Conclusions:
- Watchman device implantation leads to significant LAA orifice enlargement and increased circularity.
- LAA occlusion does not appear to adversely affect the hemodynamics of the adjacent LUPV.
- These findings support the safety of Watchman device placement regarding adjacent pulmonary vein flow.
Abstract:
Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics. We included 50 patients who underwent percutaneous LAA occlusion with the Watchman device and had acceptable three-dimensional transesophageal echocardiography images of LAA pre- and post-device placement. We measured offline the LAA orifice diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre- and post-procedure were also measured. Patients were elderly (mean age 76 ± 8 years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1 ± 3.2 vs. post-device 21.5 ± 3.4 mm, p < 0.001), diameter 2 (20.6 ± 3.9 vs. 22.1 ± 3.6 mm, p < 0.001), minimum diameter (17.6 ± 3.1 vs. 21.3 ± 3.4 mm, p < 0.001), maximum diameter (21.5 ± 3.9 vs. 22.4 ± 3.6 mm, p = 0.022), circumference (63.6 ± 10.7 vs. 69.6 ± 10.5 mm, p < 0.001), and area (3.1 ± 1.1 vs. 3.9 ± 1.2 cm2, p < 0.001). Eccentricity index decreased after procedure (1.23 ± 0.16 vs. 1.06 ± 0.06, p < 0.001). LUPV peak S and D velocities did not show a significant difference (0.29 ± 0.15 vs. 0.30 ± 0.14 cm/s, p = 0.637; and 0.47 ± 0.19 vs. 0.48 ± 0.20 cm/s, p = 0.549; respectively). LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.
