Three-Dimensional Printing in Guiding Management of Left Atrial Appendage Occlusion Device Migration

Left atrial appendage occlusion (LAAO) device migration is rare and may require surgical retrieval. Conventional imaging can be limited in assessing device stability within complex appendage anatomy.

A 79-year-old woman underwent Watchman FLX Pro implantation during atrial fibrillation ablation. At 45 days, computed tomography and transesophageal echocardiography revealed device tilt and a peridevice leak, prompting concern for malposition. Three-dimensional (3D) printing derived from computed tomography showed that approximately 70% of the device was seated and partially endothelialized, suggesting stability. Surgical retrieval was deemed high risk, and the device was left in situ with continued anticoagulation. Six-month imaging confirmed stable position without complications.

This case demonstrates how 3D printing can clarify ambiguous imaging findings and directly influence management decisions in complex LAAO cases, shifting therapy from surgical intervention to conservative monitoring.

When conventional imaging is equivocal, 3D printing provides valuable anatomical insight, supporting personalized, multidisciplinary decision-making.