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His left atrial appendage was ligated during prior mitral valve surgery, but was noted to be patent on a recent transesophageal echocardiography. An Amulet device was selected based on CT planning. This report describes a challenging appendage anatomy unsuitable for the commercial devices, managed successfully with an off\u2010label device.<\/jats:p>","DOI":"10.1002\/ccd.70909","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:27:37Z","timestamp":1790141257000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Left Atrial Appendage Closure Using a PFO Occluder After an Incomplete Surgical Ligation"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4953-7696","authenticated-orcid":false,"given":"Zach","family":"Rozenbaum","sequence":"first","affiliation":[{"name":"Department of Cardiology Tulane University New Orleans Louisiana USA"},{"name":"Department of Cardiology Barzilai Medical Center Ashkelon Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Gnall","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lankenau Medical Center Wynnewood Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"issue":"12","key":"e_1_2_9_2_1","article-title":"Left Atrial Extra\u2010Appendicular Trabeculations During Appendage Closure: A Word of Caution","volume":"15","author":"Rozenbaum Z.","year":"2022","journal-title":"Circulation: Cardiovascular Imaging"},{"issue":"7","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.hrthm.2015.03.028","article-title":"Association Between Incomplete Surgical Ligation of Left Atrial Appendage and Stroke and Systemic Embolization","volume":"12","author":"Aryana A.","year":"2015","journal-title":"Heart Rhythm: The Official Journal of the Heart Rhythm Society"},{"issue":"4","key":"e_1_2_9_4_1","first-page":"1141","article-title":"Leak Closure Following Left Atrial Appendage Exclusion Procedures: A Multicenter Registry","volume":"99","author":"Alkhouli M.","year":"2022","journal-title":"Catheterization and Cardiovascular Interventions"},{"issue":"1","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.hrthm.2018.07.017","article-title":"Feasibility of Left Atrial Appendage Device Closure Following Chronically Failed Surgical Ligation","volume":"16","author":"Ellis C. 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