Contrast-enhanced CMR in patients after percutaneous closure of the left atrial appendage: A pilot studyReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 13:33

First Online: 04 July 2011Received: 16 February 2011Accepted: 04 July 2011

Abstract

BackgroundTo evaluate the feasibility and value of first-pass contrast-enhanced dynamic and post-contrast 3D CMR in patients after transcatheter occlusion of left atrial appendage LAA to identify incorrect placement and persistent leaks.

Methods7 patients with different occluder systems n = 4 PLAATO; n = 2 Watchman; n = 1 ACP underwent 2 contrast-enhanced Gd-DOTA CMR sequences 2D TrueFISP first-pass perfusion and 3D-TurboFLASH to assess localization, artifact size and potential leaks of the devices. Perfusion CMR was analyzed visually and semi-quantitatively to identify potential leaks.

ResultsAll occluders were positioned within the LAA. The ACP occluder presented the most extensive artifact size. Visual assessment revealed a residual perfusion of the LAA apex in 4 cases using first-pass perfusion and 3D-TurboFLASH indicating a suboptimal LAA occlusion.

By assessing signal-to-time-curves the cases with a visually detected leak showed a 9-fold higher signal-peak in the LAA apex 567 ± 120% increase from baseline signal than those without a leak 61 ± 22%; p < 0.03. In contrast, the signal increase in LAA proximal to the occluder showed no difference leak 481 ± 201% vs. no leak 478 ± 125%; p = 0.48.

ConclusionThis CMR pilot study provides valuable non-invasive information in patients after transcatheter occlusion of the LAA to identify correct placement and potential leaks. We recommend incorporating CMR in future clinical studies to evaluate new device types.

AbbreviationsLAAleft atrial appendage

CMRcardiac magnetic resonance imaging

Gd-DOTAgadolinium gadoterate meglumin

3Dthree-dimensional

FLASHfast-low-angle-shot

FISPFast Imaging with Steady State Precession

SSFPsteady-state-with-free-precession

ROIregion of interest

CTcomputed tomography.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-33 contains supplementary material, which is available to authorized users.

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Author: Oliver K Mohrs - Nina Wunderlich - Steffen E Petersen - Anselm Pottmeyer - Hans-Ulrich Kauczor

Source: https://link.springer.com/article/10.1186/1532-429X-13-33







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