Figure 5.

WATCHMAN device. (A–C) Show the delivery (A), deployment (B), and release (C) of the WATCHMAN device through a 12-Fr transseptal delivery sheath. (D) Shows a close-up view of the WATCHMAN device—consisting of a self-expanding nitinol frame covered with a porous filtering PET membrane. The stability of the device is secured by fixation barbs located circumferentially; the PET membrane acts as a filter preventing the outflow of the thrombi and promotes endothelialisation. The device is available in five different sizes ranging from 21 to 33 mm, and is normally selected 10–20% larger than the left atrial appendage (LAA) diameter to ensure stable device positioning. The device can be recaptured and withdrawn in case of suboptimal fixation. The WATCMAN device received CE-mark approval in 2005 and is currently used in clinical practice. (E) Shows a transoesophageal echocardiography image of an occluded LAA following deployment of a WATCHMAN device—the delivery cable is still connected to the device. (F) Shows a cine image of an LA angiogram demonstrating a WATCHMAN device properly deployed inside the LAA (black arrow). TSS, transseptal sheath. Images reproduced with permission from Aryana et al.⁴⁷