 and then shetty interventional cardiologist in Manipura hospital by good left-eater appendage is done like an angiogram thereby it's not a operative procedure but interventional procedure so what is done is it's done under either local anesthesia or a short general anesthesia not a long general anesthesia which is needed for surgery and it done through the leg you go through the femoral vein go to the right side of the heart through the inter-eateral septum enter the left side of the heart identify where the left-eater appendage is and then take one angiogram the procedure is done under eco guidance which is called as a trans esophageal eco and device is applied as food so that there is a complete obliteration of left-eater appendage this left-eater appendage is like appendage so it is not really needed for normal functioning of the heart but can produce lots of harm especially natal fibrillation where it can form the clot and the clot can go to brain and people can get stroke now there are two devices which are right now approved and available in India one is called the ACP or amplansal cardiac plug which has been available for a lot of time now and it is CEMA the second device which is available is a watchmen device which does have lots of data and it is US FDA approval so this procedure is 97% safe and the complications are 1 to 3 percent most complication include local bleeding and bleeding into heart and that is something which we need to look up to so overall done when in good hands running a good center the risk of complications much lesser than the benefit this procedure can offer