Alberto Maria Lanzone

Istituto Clinico HUMANITAS Gavazzeni

Bergamo

AMPLATZER™ AMULET

The AMPLATZER™ Cardiac Plug or AMULET are percutaneous transcatheter devices intended for cardiac structures not involving the septal wall, which require closure or occlusion. One intended use is the nonsurgical closure of the left atrial appendage.

Patient selection, imaging and device selection is critical for the successful implantation of the ACP.

The AMPLATZER™ AMULET is contraindicated for the following:

Patients with the presence of intracardiacthrombus.

Patients with active endocarditis or other infections producing bacteremia.

Patients where placement of the device would interfere with any intracardiac or intravascular structures. (mitral valve, circumflex artery, etc.)

MV

LSPV

LIPV

LAA

LSPV

LIPVRIPV

RSPV

RIPV

LS

LI

RSPV

A B

C D

LSPV

LIPV

LAA

Mitral valve

superior wall

poste

rior

wall

an

terio

r w

all

23% of hearts

Left Atrial Appendage Measurements

Veinot, John; Harrity, Phillip; Gentile, Federico; Khandheria, Bijoy; Bailey, Kent; Eickholt, Jeffrey; Seward, James; Tajik, A; Edwards, William. Circulation. 96(9):3112-3115, November 4, 1997.

Anatomy of the Normal Left Atrial Appendage: A Quantitative Study of Age-Related Changes in 500 Autopsy Hearts: Implications for Echocardiographic Examination.

Diameter: 1,11± 0,33Width: 1,70 ± 0,60Length: 2,56 ± 0,72

The appendages had 2–5 branches and 0–12 twigs

The mean angle of the first bend was 134°

The morphological appearanceof the LAA could be classified into two types: slender like a crooked finger (81.8%)and stump-like (18.2%).

The principal axis was: -tortuosus and spiraled in 42% of hearts, - extremely bent and slightly spiraled in 24%, - slightly bent and extremely spiraled in 5% -and slighly bent and spiraled in 23%

P Su, K P McCarthy, S Y Ho Heart 2008;94:1166–1170.

Mitral Valve

Pectinate Muscles

VI

Frontal Section(four chamber)

INTERNAL MORPHOLOGY

PectinateMuscles areinside

But ………..not only

Circunflexartery

MajorCardiacvein

Extra-appendicularPectinate Muscle

Extra-appendicularPectinate Muscle

Extra-appendicularPectinate Muscle

CircunflexArtery

Major CoronaryVein

MitralValve

Coronary sinus

orifice

LeftAtrium

Left Superior Pulmonary Vein

ICV

FrontalSection (four chambers)

Cortesy of:

Profesor Damián Sánchez Quintana

Dpto. de AnatomiaHumana

Facultad deMedicina

Universidad Extremadura

CircunflexArtery

Major CoronaryVein

MitralValve

Coronary sinus

orifice

LeftAtrium

Left Superior Pulmonary Vein

ICV

Extra-appendicularPectinate Muscle

Potentially, the left superior

pulmonary vein, mitral valve

and anterior descending CA

can be at risk during

occlusion of the LAA.