Gigantic rare left atrial appendage with four lobes closed using a Watchman FLX and LAmbre closure device in the kissing technique: A Case Report

Abstract Introduction Despite the growing experience with left atrial appendage closure and the variety of closure devices and techniques, challenges remain in some cases due to anatomical complexities and varieties. Methods We report a case of rare and complex LAA anatomy. Cardiac computed tomography and angiography demonstrated a gigantic LAA with four lobes at the level of the ostium that cannot be occluded by the currently approved LAA closure devices in Europe. . Results Watchman FLX (27 mm plug) and LAmbre (16/22 mm lobe/disc) closure devices in the kissing technique were successfully deployed under fluoroscopy and transesophageal echocardiogram guidance without procedure-related complications. Conclusion Watchman FLX (plug) and LAmbre (umbrella and disc) Kissing is feasible. The LAmbre device may close very small or large LAAs with anatomical complexity.