AMPLATZER™ AMULET

1. Alberto Maria Lanzone
Istituto Clinico HUMANITAS Gavazzeni
Bergamo
AMPLATZER™ AMULET

2. 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.

3. The AMPLATZER™ AMULET is contraindicated for the
following:
Patients with the presence of intracardiac
thrombus.
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.)

4. MV
LSPV
LIPV
LAA
LSPV
LIPV
RIPV
RSPV
RIPV
LS
LI
RSPV
A B
C D
LSPV
LIPV
LAA
Mitral valve
superior wall
posteriorwall
anteriorwall
23% of hearts

5. 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± 0,33
Width: 1,70 ± 0,60
Length: 2,56 ± 0,72

6. The appendages had
2–5 branches
and 0–12 twigs
The mean angle of the first
bend was 134°
The morphological appearance
of 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.

7. Mitral
Valve
Pectinate
Muscles
VI
Frontal Section
(four chamber)
INTERNAL
MORPHOLOGY
Pectinate
Muscles are
inside
But ………..
not only

8. Circunflex
artery
Major
Cardiac
vein
Extra-appendicular
Pectinate Muscle
Extra-appendicular
Pectinate Muscle
Extra-appendicular
Pectinate Muscle

9. Circunflex
Artery
Major
Coronary
Vein
Mitral
Valve
Coronary
sinus
orifice
Left
Atrium
Left Superior
PulmonaryVein
ICV
Frontal
Section
(four chambers)
Cortesy
of:
Profesor
Damián
Sánchez
Quintana
Dpto. de
Anatomia
Humana
Facultad de
Medicina
Universidad
Extremadura

10. Circunflex
Artery
Major
Coronary
Vein
Mitral
Valve
Coronary
sinus
orifice
Left
Atrium
Left Superior
PulmonaryVein
ICV
Extra-appendicular
Pectinate Muscle
Potentially, the left superior
pulmonary vein, mitral valve
and anterior descendingCA
can be at risk during
occlusion of the LAA.