Left atrial appendage closure

Step-by-step LAA occlusion

Transseptal access and LAA imaging

A radial artery line is recommended to have constant blood pressure monitoring before starting the procedure. Constant monitoring may allow early detection of a complication such as pericardial effusion or air embolisation.

Femoral venous access is generally obtained in the right femoral vein as it allows an easier and more precise transseptal puncture. Transseptal puncture is performed under fluoroscopic and TEE guidance in the inferior and posterior part of the fossa ovalis using a BRK-0 (minor curve) or BRK-1 (large curve) needle (Figure 7).

BRK and BRK-1 transseptal needles.
BRK: Brockenbrough

Large curve needles might be necessary in case of severe vein tortuosity, heart rotation or to get proper contact in case of lipomatous septums. If the interatrial septum is thick and difficult to puncture, diathermy or radiofrequency needles may be used to cross the septum. Transseptal accuracy is pivotal in order to avoid complications and approach the LAA as coaxially as possible. A more coaxial approach of the LAA will reduce the catheter manipulation and ease the implantation of any occlusion device. TEE guidance of transseptal puncture is of particular...