Clinical Case Study: Watchman™ Deployment with ACUSON AcuNav Volume ICE Catheter

Case courtesy of Dr. Carlos Sanchez, Associate Professor of Medicine, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA

Both 2D and 4D color Doppler assessment were used to evaluate the presence of any residual leak around the device before and after deployment.

A pre-procedural computed-tomography (CT) exam with contrast was performed to evaluate the anatomy and dimensions of the Left Atrial Appendage (LAA).

CT scan reconstructions included multiplanar reformats according to left atrial appendage closure protocol.

The estimated LAA ostium measurement was determined to be 18.2 mm.

Prior to intervention, using the ACUSON AcuNav Volume catheter in the 2D imaging mode, baseline imaging and measurements were obtained of the Left Atrial Appendage.

An anatomical overview was conducted to include evaluation of the pericardial space to rule out effusion.

*This image should be obtained post deployment as well.

Measurements were then obtained using the multiplanar reconstruction planes (MPR). The coronal plane measurements were the most useful in helping determine device size.

The AcuNav Volume ICE catheter allows the clinician to obtain multiple measurements of the LAA efficiently, meeting the PASS criteria, reducing multiple angles in separate views. By comparison, the transesophageal (TEE) exam requires measurements be obtained in multiple angles from separate views.

To generate left atrial appendage ostium diameter and appendage depth measurements, multiplanar reconstruction planes were used to determine appropriate device size. 

The ACUSON AcuNav Volume catheter was then positioned in the mid-right atrium in the “Home View.” The catheter was rotated clockwise to approximately the 4 o’clock position to obtain the atrial septal view.

The recommended septal location for a transseptal puncture, providing best access to the left atrial appendage, is in the posterior-inferior region of the atrial septum.

Upon completion of the transseptal puncture, a wire was then placed into the left atrium as a guide.

As demonstrated in this example, under fluoroscopy and Volume ICE guidance, the atrial septum was then dilated for insertion of the ACUSON AcuNav Volume catheter.

This workflow helped with the positioning of the Volume ICE catheter into the left atrium.

Position: device is distal to or at the ostium of the LAA and there is no tilt.

Anchor: fixation anchors engaged and device is stable; “Tug Test” is performed

Size: device is compressed at least 8 – 20% of original size²

Seal: device spans ostium and all lobes are covered; no paradevice leak.

Once the device is opened in the LAA the MPR’s were again used to align for the best measurement planes. This was used to determine compression of the device in the LAA prior to deployment.

Multiple measurements were then made in the coronal plane. 

Once the device is opened in the LAA the MPR’s were again used to align for the best measurement planes. This was used to determine compression of the device in the LAA prior to deployment.

Multiple measurements were then made in the coronal plane.

Both 2D and 4D color Doppler assessment were used to evaluate the presence of any residual leak around the device before and after deployment.

Both 2D and 4D color Doppler assessment were used to evaluate the presence of any residual leak around the device before and after deployment.