First TEE after watchman

I will be having my first TEE after my watchman implant the end of the month. I could not stay off of Dr. Google and this is the first thing I read dated April 21, 2022, “patients who have residual leaks greater than 5 millimeters across should be considered to have a failed procedure,”. Soooo, my anxiety level is high. I know there were discussions in this forum about plugs being put in for leaks and I was told that Dr. Natale has his own way to handle the leaks. I never asked about the size, however, and if some could not be fixed!

Looking for responses to help with the anxiety.

Natale leaving a leak that large would be extraordinarily unlikely. That's just not going to happen. Remember, they checked for leaks when they implanted the Watchman, so for a large leak to develop the device would have had to shift or something, and that's also not going to happen. It has metal teeth all the way around it that hold it in place, and when it was implanted Natale would have done a tug test. He literally tugged on the device several times to see if it can be moved. If it can, it gets repositioned and retested.

If there is a small leak, it can be plugged in a very short procedure. Out of the dozen or so people I know of who've had a Watchman, not one of them had a leak of any size. To my knowledge Natale uses the same vascular plugs other EPs use for that purpose.

I've never heard of a Watchman having an unfixable leak. That's just not a thing.

Relax and quit reading Dr. Google. Your mind is going to instinctively seek out all the worst outcomes and that's what you'll focus on. This is a simple procedure with no real bad outcomes.

Thank you, Carey.

I will check this one off of my list.

Dr Natale was a wizard with my watchman. I had a usual size LAA with a long shoulder and he did a flawless leak-proof job. My problem was the vein(?) while he inserted my watchman, the vein was kinked up snd curved and he was successful in passing that area without any tears. Absolutely a perfect job.

You should be fine.

Thanks, Susan, for your response. I am sorry you usually have personal issues that you can relate to. I am glad that you always seem to conquer those!

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susan.d
I had a usual size LAA with a long shoulder

I think maybe you mistyped and meant unusual?

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Carey

I had a usual size LAA with a long shoulder

I think maybe you mistyped and meant unusual?

:-)
“Usual” mishap for me having a curved LAA and veins, unusual to the general population. Yes a typo.

I too had Dr Natale place my Watchman on 2-16-22. 5 weeks after covid!! He agreed for my TEE to be here in Charlotte with all results transmitted to Austin. My EP here: Warren Holshouser called me on 4-1-22 and said it was perfect , no leaks gaps nor risidual flow. Said it could not look any better. So i agree with Carey that any leaks etc are pretty unlikely. I of course tried to consume anything that might promote endothelial healing. So i did & still use collagen powder. 400 IU of ubiquinol. Zinc C D and rotate many oils in small amounts ea day. I also exercise
Youll be fine

I unfortunately have a leak.

Was seen on my first TEE and unchanged on my second, six month TEE.

“There is trace leak (< 3mm) of the Watchman device unchanged from the prior exam.There is
a small thrombus visualized inside of the appendage.”

Also “Iatrogenic Atrial Septal Defect with left to right shunt is present.“ which is also apparently a rare occurrence?

I guess I’m good at the “unlikely”?

It’s not clear to me how or if these things will be fixed,



Edited 1 time(s). Last edit at 11/01/2022 07:43PM by Mac.

They don't generally do anything about a 3mm leak. If they want to fix it, they insert a small vascular plug in the leak.

And an ASD with no left-to-right shunt doesn't need treatment either. I have one of those, too.

"iatrogenic" vs. "latrogenic.."

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gloaming
"iatrogenic" vs. "latrogenic.."

Huh? You spelled it right the first time.

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Carey
They don't generally do anything about a 3mm leak. If they want to fix it, they insert a small vascular plug in the leak.

And an ASD with no left-to-right shunt doesn't need treatment either. I have one of those, too.

You said an ASD with NO left to right shunt doesn’t need treatment.

My report (which I cut and pasted the quote from to be sure it is accurate) says I DO have the left to right shunt.

So will that need treatment? Can it heal itself?



Edited 1 time(s). Last edit at 11/03/2022 03:59AM by Mac.

Sorry, typo on my part. Did they mention having done a bubble study? I doubt it needs treatment either way. They'd be talking about if it they thought so. ASDs are really common and don't usually require treatment.

I do not have a watchman but had LAA surgical closure 15 years ago. I have an ASD from that - they see it when I get an ECHO - no treatment required. No affects that I can tell.

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Carey
Sorry, typo on my part. Did they mention having done a bubble study? I doubt it needs treatment either way. They'd be talking about if it they thought so. ASDs are really common and don't usually require treatment.

The atrial septal puncture from inserting my MitraClip over three years ago has never completely healed—there is still a tiny pinhole (the MitraClip is the largest thing they push through the wall). I told Natale that my latest echo still shows this and he said that it might never completely heal and that it was okay.

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gloaming
"iatrogenic" vs. "latrogenic.."

I know...

The quoted text a few posts above looks like an 'L' on my display. It's nothing, just wondered if this was deliberate or a typo.