Complex left atrial appendage closure using 3D printing system simulation in a patient with mitral prosthetic valve: a case report.

Background: Left atrial appendage (LAA) closure (LAAc) has emerged as a safe and effective alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF) and contraindications to OAC.

Case summary: A 61-year-old woman with permanent AF and a history of mitral surgery replacement with mechanical prosthesis was referred to our cardiology department to undergo LAAc. The preoperative computed tomography (CT) revealed that the ostium of the LAA was close to the mitral prosthesis ring. As a result of the difficult LAA morphology, a CT image-based virtual model was created, then a 3D printing model was prepared in our laboratory, and procedure simulation was performed with the two different LAA occlusion devices (plug- vs. pacifier-like models) to see which one was more suitable for the patient anatomy.

Discussion: In this case of complex LAAc in a patient with mechanical prosthetic mitral valve, the use of a 3D printed model has guided prosthesis selection and device sizing reducing procedure time and complications.