Occluding the left atrial appendage: anatomical considerations

Su, Peiqi; McCarthy, Karen; Ho, Siew Yen

doi:10.1136/hrt.2006.111989

Cited by 150 publications

(115 citation statements)

References 18 publications

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“…It comprises a single layer of endothelium and is trabeculated with underlying pectinate muscles lining the cavity. The LAA varies considerably in size from 16-51mm in length, 10-40mm in diameter and 0.77-19.27cm 3 in volume [5,6]. The LAA also appears to differ in morphology with distinct variants including the 'chicken wing', 'cactus', 'windsock' and 'cauliflower' being described in 48%, 30%, 19% and 3% of cases respectively [7].…”

Section: Laa Anatomymentioning

confidence: 99%

The Left Atrial Appendage in Health and Disease

Howlett¹

2015

MOJAP

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Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia and results in significant morbidity and mortality. The left atrial appendage (LAA), a small embryonic remnant of the left atrium (LA), has been shown to play a key role in the pathophysiology of AF-related stroke and thromboembolism. As a consequence the LAA, in spite of its meagre size, has been described as 'our most lethal human attachment'. Despite being a recognised harbinger of disease, the LAA has also been shown to play an important role in health. This review seeks to address our current understanding of this vital structure in both health and disease states.

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Section: Laa Anatomymentioning

confidence: 99%

The Left Atrial Appendage in Health and Disease

Howlett¹

2015

MOJAP

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“…The depth is measured in the main lobe of the LAA. The shape of the LAA ostium is typically elliptical; other shapes have been less frequently described [13,15]. Markedly oval-shaped orifices or landing zones are associated with a significant difference between maximal and minimal diameters, which can be confounding and may lead to overor under-sizing.…”

Section: International Journal Of Cardiovascular Practicementioning

confidence: 99%

Role of Imaging in Left Atrial Appendage Occlusion

Lempereur

Aminian

Potter

et al. 2017

ijcp

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Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to longterm oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure.

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“…The ranges and frequencies of orientation were similar between sexes, with a slightly higher frequency of retroverted LAAs in women (16%) than in men (6%), device design and procedural technique. As the thin walls of the LAA (muscular wall ≤1 mm) are vulnerable, device maneuvering during the procedure [18] together with anatomical variation in the LAA may partly explain the most common (4-5%) [5,6] risk of perforation and pericardial hemorrhage. Malalignment of the delivery system with the central axis of the LAA may cause tension/stress on the LAA or may result in suboptimal device positioning, leading to more manipulations including device recapturing and redeployment.…”

Section: Orientation/angulationmentioning

confidence: 99%

Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation

Joy¹,

Bertog²,

Betts³

et al. 2017

jshd

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Aims: Percutaneous left atrial appendage (LAA) occlusion has now become a suitable alternative to oral anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). However, LAA closure can be technically challenging and results suboptimal, in part due to variable left atrial anatomy.We aimed to characterize LAA morphology and identify potential anatomical pitfalls during LAA closure or LAA thrombus detection during transoesophageal echocardiography (TOE). Methods and Results: 103 patients with AF underwent cardiac magnetic resonance angiography to assess pulmonary venous anatomy. Adequate imaging quality was present in 76 in whom LAA morphology was assessed. The majority of LAAs (71%) were anterolaterally directed and 82% were 'claw'-shaped. However, there was significant variation in anatomy and course in the remainder: 11% were anteverted, 9% laterally directed and 9% retroverted. The shape was cone-like in 8%, fan-like in 5% and s-configured in 5% and there was significant variation in the curvature of the LAA body. While 66% had a single lobe, 30% were bilobed and 4% trilobed; 90% also had additional lobules. Conclusion: Our results demonstrate the significant variability of LAA geometry in AF patients. This may have implications for future device design for percutaneous LAA occlusion. The variable anatomy may affect LAA thrombus detection with TOE emphasizing the importance of multiple views to ensure complete assessment.

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Occluding the left atrial appendage: anatomical considerations

Abstract: The LAA orifice is oval shaped and thin areas of appendage wall and atrial wall are common. Potentially, the left superior pulmonary vein, mitral valve and anterior descending coronary artery can be at risk during occlusion of the os.

Cited by 150 publications

References 18 publications

The Left Atrial Appendage in Health and Disease

The Left Atrial Appendage in Health and Disease

Role of Imaging in Left Atrial Appendage Occlusion

Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation

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