Three-Dimensional Printing for Planning Occlusion Procedure for a Double-Lobed Left Atrial Appendage

A 78-year-old woman with atrial fibrillation and contraindication to oral anticoagulation because of high bleeding risk was referred for catheter-based left atrial appendage (LAA) occlusion. Preprocedural transesophageal echocardiography (TEE) using the biplane mode showed an LAA with double-lobed anatomy with a dominant posterior lobe (p) and an accessory anterior lobe (a; Figure [A]). It was thought that successful LAA occluder implantation may be made more challenging by this anatomy because it is necessary to occlude the ostia of both lobes with the device. For better planning, we decided to simulate the actual procedure using three-dimensional (3D) printing technology. A computer-based hollow cast of the LAA was created from the 3D TEE data set and then converted to a stereolithography file for 3D printing using dedicated software (Mimics, Materialize Software, Leuven, Belgium; …