Transjugular Left Atrial Appendage Occlusion in a Patient With Anomalous Inferior Vena Cava
Recommended Citation
Yap RL, Giacaman AS, Lai K, Dawdy JA, Lee JC, Gonzalez PE, O’Neill BP, Frisoli TM, O’Neill WW, Villablanca PA. Transjugular Watchman Implantation for Left Atrial Appendage Occlusion in Anomalous Inferior Vena Cava. JACC Case Rep. 2026;31(36):109187.
Document Type
Article
Publication Date
9-9-2026
Publication Title
JACC Case Rep
Abstract
OBJECTIVE: We report a successful right transjugular Watchman device implantation for left atrial appendage (LAA) occlusion in a patient with anomalous inferior vena cava with azygos continuation, precluding standard transfemoral venous access.
KEY STEPS: Ultrasound-guided right internal jugular venous access was obtained and upsized to accommodate the delivery system. Transseptal puncture was performed using an Agilis NxT medium-curve steerable sheath with microcatheter and wire exchanges, followed by staged balloon septal dilatation. The delivery sheath was successfully advanced into the LAA, and the Watchman device was successfully deployed.
POTENTIAL PITFALLS: Transjugular LAA occlusion presents unique challenges, including an angulated trajectory, increased risk of carotid injury, technically demanding transseptal puncture, and suboptimal LAA coaxial alignment, necessitating meticulous ultrasound-guided access and continuous transesophageal echocardiographic and fluoroscopic guidance.
TAKE-HOME MESSAGES: Transjugular LAA occlusion is feasible but technically demanding. Individualized procedural planning, meticulous imaging guidance, and operator adaptive techniques are critical determinants of procedural success and optimal patient outcomes.
PubMed ID
42461177
Volume
31
Issue
36
First Page
109187
Last Page
109187
