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He had atrial fibrillation with high thromboembolic risk (CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc=4) and oral anticoagulation was formally contraindicated because of recurrent severe bleeding. Selective angiography of the LAA (Video 1) showed a close relationship between the LAA (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, asterisk) and the circumflex artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, arrow), well defined by the previously implanted stents. A computed tomography scan performed after a previous episode of diffuse alveolar hemorrhage showed similar findings (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, arrow). A 22-mm Amplatzer Amulet device was successfully placed, with no residual leak. Intraoperative monitoring by transesophageal echocardiography and post-procedural radioscopy confirmed the close relationship between the device and the circumflex artery (<a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>, Videos 2 and 3), which is vital to keep in mind in order to prevent complications during the procedure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">LAA closure is a safe and effective intervention used to prevent stroke and systemic embolism in patients with atrial fibrillation and contraindications for oral anticoagulation. Nevertheless, there may be procedure-related complications such as device embolization and left atrial wall perforation. The close relationship between the LAA and circumflex artery place this latter structure and its branches (including the sinus node artery in 30% of patients) at risk during the procedure. This condition must be considered if the patient develops atrial arrhythmias or signs of myocardial ischemia during the procedure.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-11" "fechaAceptado" => "2015-05-02" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1632 "Ancho" => 1625 "Tamanyo" => 347198 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Selective angiography of the left atrial appendage using a pigtail catheter shows the relationship between this structure (asterisk) and the stents previously implanted in the mid-circumflex artery (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1327 "Ancho" => 1626 "Tamanyo" => 242555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography performed after an episode of alveolar hemorrhage also reveal the proximity of the circumflex artery to the left atrium and left atrial appendage (arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 738 "Ancho" => 3333 "Tamanyo" => 185774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intraoperative monitoring of deployment of the Amplatzer device by transesophageal echocardiography (A–D). Stents previously placed in the circumflex artery (yellow arrows) can be seen in the vicinity of the left atrial appendage, immediately next to the device landing zone.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1458 "Ancho" => 1459 "Tamanyo" => 298778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After the Amplatzer was completely deployed, radioscopy confirmed the relationship between the distal lobe of the device and the coronary artery. Although in this patient this latter structure was easily delineated by the previously implanted stents, it is vital to consider this anatomical relationship during the occlusion procedure.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1303633 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 5 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 2619037 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 6 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 1425004 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" ] "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915002263/v2_201703210134/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000010/v2_201703210134/S2174204915002263/v2_201703210134/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002263?idApp=UINPBA00004E" ]
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2020 June | 32 | 11 | 43 |
2020 May | 43 | 4 | 47 |
2020 April | 52 | 14 | 66 |
2020 March | 66 | 15 | 81 |
2020 February | 121 | 42 | 163 |
2020 January | 42 | 4 | 46 |
2019 December | 61 | 6 | 67 |
2019 November | 46 | 9 | 55 |
2019 October | 25 | 8 | 33 |
2019 September | 61 | 4 | 65 |
2019 August | 25 | 4 | 29 |
2019 July | 32 | 7 | 39 |
2019 June | 48 | 13 | 61 |
2019 May | 31 | 9 | 40 |
2019 April | 14 | 15 | 29 |
2019 March | 34 | 10 | 44 |
2019 February | 40 | 14 | 54 |
2019 January | 35 | 8 | 43 |
2018 December | 21 | 10 | 31 |
2018 November | 72 | 12 | 84 |
2018 October | 132 | 8 | 140 |
2018 September | 38 | 8 | 46 |
2018 August | 41 | 5 | 46 |
2018 July | 38 | 4 | 42 |
2018 June | 45 | 5 | 50 |
2018 May | 55 | 6 | 61 |
2018 April | 59 | 6 | 65 |
2018 March | 67 | 5 | 72 |
2018 February | 38 | 4 | 42 |
2018 January | 31 | 3 | 34 |
2017 December | 44 | 5 | 49 |
2017 November | 19 | 6 | 25 |
2017 October | 21 | 5 | 26 |
2017 September | 18 | 8 | 26 |
2017 August | 18 | 10 | 28 |
2017 July | 17 | 8 | 25 |
2017 June | 21 | 4 | 25 |
2017 May | 41 | 2 | 43 |
2017 April | 16 | 2 | 18 |
2017 March | 35 | 51 | 86 |
2017 February | 37 | 3 | 40 |
2017 January | 47 | 4 | 51 |
2016 December | 42 | 6 | 48 |
2016 November | 22 | 2 | 24 |
2016 October | 34 | 11 | 45 |
2016 September | 36 | 2 | 38 |
2016 August | 12 | 1 | 13 |
2016 July | 7 | 3 | 10 |
2016 June | 10 | 2 | 12 |
2016 May | 14 | 7 | 21 |
2016 April | 19 | 8 | 27 |
2016 March | 16 | 8 | 24 |
2016 February | 31 | 9 | 40 |
2016 January | 20 | 13 | 33 |
2015 December | 18 | 7 | 25 |
2015 November | 31 | 14 | 45 |