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<p>Percutaneous left atrial appendage (LAA) closure in giant anatomies remains a clinical challenge, especially when associated with suboptimal transseptal access due to previous cardiac surgery. A 72-year-old male with permanent atrial fibrillation and previous surgical mitral repair was referred for LAA closure. Pre-procedural 3D transesophageal echocardiography (TOE) revealed a giant LAA with a 43&#xa0;mm depth and a 38&#xa0;mm maximal ostium. Due to previous surgical interatrial sutures, transseptal puncture was restricted to an unfavorable, non-coaxial position. The procedure was successfully performed by combining a 40&#xa0;mm Watchman FLX Pro device with a steerable access sheath, which provided the necessary deflection to achieve coaxial alignment and complete ostial sealing.This case highlights the technical synergy between large-bore occluders and steerable delivery systems in overcoming extreme anatomical and procedural constraints during LAA closure.</p>

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Giant left atrial appendage closure with the 40 mm watchman FLX pro: overcoming challenging anatomy and transseptal access

  • 期刊论文

  • 发表日期：

    2026年4月22日

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  • Giuseppe Romano,
  • Pietro Pieri,
  • Elio Pieri,
  • Vincenzo Polizzi

摘要

Percutaneous left atrial appendage (LAA) closure in giant anatomies remains a clinical challenge, especially when associated with suboptimal transseptal access due to previous cardiac surgery. A 72-year-old male with permanent atrial fibrillation and previous surgical mitral repair was referred for LAA closure. Pre-procedural 3D transesophageal echocardiography (TOE) revealed a giant LAA with a 43 mm depth and a 38 mm maximal ostium. Due to previous surgical interatrial sutures, transseptal puncture was restricted to an unfavorable, non-coaxial position. The procedure was successfully performed by combining a 40 mm Watchman FLX Pro device with a steerable access sheath, which provided the necessary deflection to achieve coaxial alignment and complete ostial sealing.This case highlights the technical synergy between large-bore occluders and steerable delivery systems in overcoming extreme anatomical and procedural constraints during LAA closure.