Congenital Absence of the Left Atrial Appendage: Role of Multimodality Imaging

Arguelles, Eric; Mihalatos, Dennis; Leung, Amanda; Colangelo, Roberto G.; Jayam, Vinod; Fujikura, Kana

doi:10.1016/j.case.2023.01.003

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…In 1 case the LAA absence was identified during a cardiac tomography performed for angor and dyspnea [19], in another case during TEE performed to evaluate intracardiac thrombi in a stroke patient [17] and in the last case during autopsy [11]. Only 5 patients had other congenital cardiac anomalies [4,11,18,21,22] but the embryological mechanism of this anomaly remains unknown. Only 3 patients had history of stroke and 2 compatibles with embolic process [7,17,24].…”

Section: Resultsmentioning

confidence: 99%

Congenital absence of left atrial appendage: Case report and review of the literature

Mengoni

2023

Open J Clin Med Case Rep

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Congenital absence of left atrial appendage (LAA) is a rare condition, mostly diagnosed incidentally during imaging examination intended for other purpose. We reported a case of congenital LAA absence diagnosed in a 55-years-old man by trans-esophageal echocardiography (TEE) and confirmed by computed tomography (CT). We also conducted a systematic review of the twenty-eight cases reported in the literature.

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Section: Resultsmentioning

confidence: 99%

Congenital absence of left atrial appendage: Case report and review of the literature

Mengoni

2023

Open J Clin Med Case Rep

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“…Elucidating this issue is difficult given that LAA absence has been documented, to our knowledge, in only 23 cases published in English, with notable clinical heterogeneity between reports. 1 However, it is important to note that no thrombo-embolic events have been reported in patients with absence of the LAA and concomitant atrial fibrillation. 1 Another important consideration pertains accurate diagnosis of LAA absence.…”

Section: Discussionmentioning

confidence: 98%

“… 1 However, it is important to note that no thrombo-embolic events have been reported in patients with absence of the LAA and concomitant atrial fibrillation. 1 Another important consideration pertains accurate diagnosis of LAA absence. Left atrial appendage absence is a benign condition that should be differentiated on TEE from flush appendage thrombus, anatomical variants, and obscuration from poor echocardiographic views.…”

Section: Discussionmentioning

confidence: 98%

“… 11 Evaluation with a multimodality imaging using a combination of 2D/3D TEE followed by CCT has been the most widely employed approach. 1 …”

Section: Discussionmentioning

confidence: 99%

“…Most of these cases describe LAA absence in the setting of concomitant atrial fibrillation. 1 Due to the paucity of available data, strategies for decreasing thrombo-embolic risk amongst atrial fibrillation patients with absent LAAs have not been clearly established.…”

Section: Introductionmentioning

confidence: 99%

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Weighing the risks and benefits of anticoagulation in atrial fibrillation: a case report of left atrial appendage absence in a patient referred for procedural occlusion

Lapetina Arroyo,

Barrios,

Rivera

et al. 2024

European Heart Journal - Case Reports

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Background Absence of the left atrial appendage is an exceedingly rare structural variant that could have important implications for anticoagulation regimens in patients with atrial fibrillation. Case Summary We report the case of a 63-year old Puerto Rican female with a history of hypertension, cerebral artery aneurysms and type 2 diabetes mellitus who suffered multiple hemorrhagic strokes. The patient had never received anticoagulation therapy. During the indicated stroke workup, the patient was found to have paroxysmal atrial fibrillation. Given the patients high risk for thromboembolism and contraindications to anticoagulation therapy, the patient was referred for left atrial appendage occlusion. Pre-procedural transesophageal echocardiography failed to identify the left atrial appendage. Evaluation by way of cardiac computed tomography confirmed absence of the left atrial appendage. Left atrial appendage occlusion could not be carried out. The patient had been deemed being at high risk of bleeding, was not anticoagulated, and was instead closely followed. The patient has not had thromboembolic events nor has she experienced a hemorrhagic stroke recurrence at follow up appointments. Discussion To our knowledge this is the first such case report that reports left atrial appendage absence in the setting of multiple hemorrhagic strokes. Given the rarity of the condition and lack of available guidelines, the most viable way to currently manage this patient population is on a case-to-case basis. However, we propose that absence of the left atrial appendage could confer a decreased risk of thromboembolic phenomena in patients with atrial fibrillation.

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Confirmation of absence: the need for advanced imaging of the left atrial appendage

Mané,

Conde,

Silva

et al. 2024

J Cardiovasc Imaging

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Congenital Absence of the Left Atrial Appendage: Role of Multimodality Imaging

Cited by 3 publications

References 12 publications

Congenital absence of left atrial appendage: Case report and review of the literature

Congenital absence of left atrial appendage: Case report and review of the literature

Weighing the risks and benefits of anticoagulation in atrial fibrillation: a case report of left atrial appendage absence in a patient referred for procedural occlusion

Confirmation of absence: the need for advanced imaging of the left atrial appendage

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