{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:18:07Z","timestamp":1790194687759,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T00:00:00Z","timestamp":1696291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the role of the CT\u2010derived angle between the intra\u2010atrial septum (IAS) and the left atrial appendage (LAA) on procedural complexity and clinical outcomes in left atrial appendage occlusion (LAAO) procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Given the broad variations in anatomy, LAAO remains one of the most challenging interventional procedures in structural heart disease. In recent years, preprocedural cardiac tomography (CT) has evolved as a valuable tool; however, prediction of procedural complexity remains cumbersome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed 47 patients that underwent LAAO at our center in whom pre\u2010procedural cardiac CT\u2010scans were available. Among other baseline parameters, we measured the angle between the LAA ostium and the preferred transseptal puncture site at the IAS. We compared patients with an angle above and below the median regarding procedural characteristics and procedural outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median angle between the LAA and the IAS was 127.3\u00b0 (IQR: 120.9\u2013141.3). LAAO took longer in patients with a measured angle below the median (55.0\u00a0\u00b1\u00a022.7\u00a0min vs. 41.3\u00a0\u00b1\u00a017.5\u00a0min; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04), resulting in longer radiation times (13.0\u00a0\u00b1\u00a05.3\u00a0min vs. 9.8\u00a0\u00b1\u00a05.7\u00a0min; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04) and more contrast use (61.1\u00a0\u00b1\u00a047.5\u00a0mL vs. 33.6\u00a0\u00b1\u00a024.7\u00a0mL; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.05). Moreover, the necessity for a sheath exchange was significantly higher (30.4%\u00a0vs. 4.2%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.02) and device repositioning or device resizing trended to be more frequent (26.1%\u00a0vs. 8.3%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.1 and 21.7%\u00a0vs. 8.3%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.2). There were no differences in procedural outcome, device\u2010position and peri\u2010device leak (PDL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The angle between the transseptal puncture site and the LAA ostium may serve as a predictor for more demanding LAAO interventions. In our study a steeper angle led to a prolonged procedure resulting in higher doses of contrast and radiation, but was not associated with a worse procedural outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15699","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T08:44:41Z","timestamp":1696409081000},"page":"1227-1236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex interventional occlusion procedures"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8938-9432","authenticated-orcid":false,"given":"Dominik","family":"Nelles","sequence":"first","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Amli","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Sugiura","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Vij","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Beiert","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Nickenig","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"K\u00fctting","sequence":"additional","affiliation":[{"name":"Department of Radiology University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Wilko","family":"Schrickel","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Sedaghat","sequence":"additional","affiliation":[{"name":"Heart Center Department of Medicine II University Hospital Bonn  Bonn Germany"},{"name":"RheinAhrCardio \u2013 Praxis f\u00fcr Kardiologie  Bad Neuenahr\u2010Ahrweiler Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.08.089"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.040"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.119.007257"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV16I9A129"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-022-00852-4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15548"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2021200136"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew212"},{"issue":"1","key":"e_1_2_10_10_1","first-page":"4","article-title":"Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, 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