Journal: Cardiovascular Engineering and Technology

Article Title: Design and Validation of a High-Fidelity Left Atrial Cardiac Simulator for the Study and Advancement of Left Atrial Appendage Occlusion

doi: 10.1007/s13239-025-00773-2

Figure Lengend Snippet: Hemodynamic changes following LAAO in LA cardiac simulator. (A) (i) LA model with acrylic cap sealed over ostium to simulate complete LAA exclusion or long-term occlusion following device endothelialization. (ii) LA model with 24 mm WATCHMAN FLX ™ Left Atrial Appendage Closure Device (Boston Scientific) deployed in LAA2. (ii) LA model with no device in LAA2. (iv) LA pressure amplitude (LAP PulsePressure = LAP maxima – LAP minima ) before (No Device) and after LAAO with a 24 mm FLX (24 mm FLX) or a silicone coated impermeable 24 mm FLX device (Coated 24 mm FLX), or exclusion with an acrylic cap (Acrylic Cap). All data collected at 60 BPM and pump SV of 90 mL. Dunnett’s T3 multiple comparisons test, **** <0.0001, *** <0.0002, ** <0.0021, * <0.0332, ns = not significant. (v) Mean flow before (No Device) and after LAAO with a silicone-coated impermeable FLX device (Coated FLX). Inflow is defined as the sum of the mean flow through the four pulmonary veins. All data collected at 70 BPM and pump SV of 70 mL or 80 mL. (vi) Mean difference in volume per beat between inflow and outflow before (No Device) and after LAAO with a silicone coated impermeable FLX device (Coated FLX). All data collected at 70 BPM and pump SV of 70 mL or 80 mL. Paired t test, p = 0.0546. LAAO: left atrial appendage occlusion; LA: left atrium; LAA: left atrial appendage; SV: stroke volume; PV: pulmonary vein. RSPV: right superior pulmonary vein; RIPV: right inferior pulmonary vein; LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; LA: left atrium; LAA: left atrial appendage; MV: mitral valve; LV: left ventricular

Article Snippet: Fig. 4 Hemodynamic changes following LAAO in LA cardiac simulator. (A) (i) LA model with acrylic cap sealed over ostium to simulate complete LAA exclusion or long-term occlusion following device endothelialization. (ii) LA model with 24 mm WATCHMAN FLX TM Left Atrial Appendage Closure Device (Boston Scientific) deployed in LAA2. (ii) LA model with no device in LAA2. (iv) LA pressure amplitude (LAP PulsePressure = LAP maxima – LAP minima ) before (No Device) and after LAAO with a 24 mm FLX (24 mm FLX) or a silicone coated impermeable 24 mm FLX device (Coated 24 mm FLX), or exclusion with an acrylic cap (Acrylic Cap).

Techniques:

Journal: Cardiovascular Engineering and Technology

Article Title: Design and Validation of a High-Fidelity Left Atrial Cardiac Simulator for the Study and Advancement of Left Atrial Appendage Occlusion

doi: 10.1007/s13239-025-00773-2

Figure Lengend Snippet: Evaluating LAAO in LA cardiac simulator. (A) Comparing occlusiveness of different devices in the cardiac simulator. (i) Following device deployment, a green dye was injected into the LAA distal to the device while color intensity was monitored in the LAA. The time to return to baseline color intensity in the LAA pre-injection was used as a surrogate for the degree of occlusiveness. Two 24 mm WATCHMAN FLX devices were deployed. The first device was a normal WATCHMAN FLX with a permeable polyethylene terephthalate (PET) fabric cover. The second device was a WATCHMAN FLX with an impermeable silicone coating on the PET fabric cover. (ii-iii) Dye was injected into the LAA and could be monitored visually for washout while pressure was measured continuously. (iii-iv, right) An endoscopic camera was used to visualize the LA portion of the device. (iv) Color intensity in the LAA following dye injection. Data are normalized from pre-injection baseline intensity to maximum intensity reached following dye injection. Time above baseline intensity indicated by shaded region. Time of dye injection indicated by vertical dashed line. (v) Time for color intensity in the LAA to decrease by 40% from maximum intensity reached post-injection. ( B) Using intracardiac echocardiography (ICE) to evaluate device placement and occlusiveness in the cardiac simulator. (i) Schematic of device placement and ICE catheter positioning within the LA. (ii) ICE image pre-injection showing device placement with no flow through the permeable PET fabric cover. (iii) ICE image during injection showing flow from the LAA through the permeable PET fabric cover towards the catheter in the LAA. ( C) Using standard echocardiography to evaluate device placement and the presence of PDL in the cardiac simulator. (i) Schematic of device placement, echo probe positioning with respect to the LAA, and endoscopic camera positioning within the LA. (ii-iv) Flow as measured by echocardiographic inside the LAA behind the device. (ii) Flow with no device in the LAA. (iii) Flow with the device placed in the LAA. (iv) Flow with the device deliberately misplaced in the LAA. (v) Device (mis)placement can be directly visualized using an endoscopic camera

Article Snippet: Fig. 4 Hemodynamic changes following LAAO in LA cardiac simulator. (A) (i) LA model with acrylic cap sealed over ostium to simulate complete LAA exclusion or long-term occlusion following device endothelialization. (ii) LA model with 24 mm WATCHMAN FLX TM Left Atrial Appendage Closure Device (Boston Scientific) deployed in LAA2. (ii) LA model with no device in LAA2. (iv) LA pressure amplitude (LAP PulsePressure = LAP maxima – LAP minima ) before (No Device) and after LAAO with a 24 mm FLX (24 mm FLX) or a silicone coated impermeable 24 mm FLX device (Coated 24 mm FLX), or exclusion with an acrylic cap (Acrylic Cap).

Techniques: Injection