Usefulness of Echocardiography Contrast Agents for the Detection of Residual Leak After Percutaneous LAA Closure Device Implantation

Abstract

Background

Residual leaks after percutaneous left atrial appendage closure (LAAC) are associated with an increase in thromboembolic events. Therefore, their detection and correction are crucial.

Case Summary

This case was a 78-year-old woman with history of long-standing atrial fibrillation complicated by transient ischemic attack who underwent a percutaneous LAAC with a WATCHMAN device, with no residual leak. Initial follow-up transesophageal echocardiography (TEE) was unremarkable and anticoagulation therapy was stopped. Subsequent TEE was performed due to abnormal gap around the device noted on cardiac computed tomography. TEE findings were concerning for residual leak by color Doppler, but a definite diagnosis could not be made. An echo contrast agent was then used, which helped establish a definite diagnosis of residual leak and helped guide further management.

Discussion

This is the first case to show the usefulness of echo contrast agents to detect residual leaks after LAAC.

Take-Home Message

The use of contrast agents during TEE represents a low-cost and readily available tool that may become an alternative to cardiac computed tomography for the detection of residual leaks after LAAC in challenging cases, when color Doppler is inconclusive.