Resection of the Left Auricular Appendix

Madden, John L.

doi:10.1001/jama.1949.02900440011003

Cited by 213 publications

(55 citation statements)

References 6 publications

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“…8,9 Unfortunately, many early surgical patients had rheumatic mitral disease and often giant immobile left atria. LAA ligation was not always effective, because in such patients clots can arise from the body of the LA itself.…”

Section: Comparison With Prior Investigationmentioning

confidence: 99%

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Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

et al. 2002

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Background-Atrial fibrillation is associated with a high risk for cardioembolic stroke. The left atrial appendage (LAA) is the source of the vast majority of these thromboemboli. A novel implanted device for percutaneous LAA transcatheter occlusion (PLAATO) has been designed to seal the LAA. The purpose of this study was to test the feasibility and safety of transcatheter LAA occlusion in dogs. Methods and Results-A PLAATO implant was delivered to the LAA through a 12F transseptal catheter in 25 dogs. The PLAATO device was repositioned until occlusion was seen, or it was recaptured and replaced with a different size. LAA sealing was confirmed by intracardiac echocardiography and contrast fluoroscopy. Follow-up was performed 2 days to 6 months after implantation. After imaging assessment, dogs were euthanized and LAA was examined for device healing, migration, perforation, and any thrombosis, both grossly and histologically. The LAA was occluded in all cases.No mobile thrombi associated with the implantation were seen. Healing on the atrial-facing surface was 90% at 1 month and was complete by 3 months, which was confirmed by gross and histological examination. Light microscopic examination of brain, kidney, and spleen showed no evidence of emboli or infarct. Conclusions-Transcatheter LAA occlusion is simple and feasible. At the follow-up study, the device remained in the LAA, with benign healing and no evidence of new thrombus or damage to surrounding structures. This new strategy may provide an alternative treatment for patients with nonvalvular atrial fibrillation who are less than optimal candidates for warfarin.

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Section: Comparison With Prior Investigationmentioning

confidence: 99%

“…8,9 It has now become routine in many centers to ligate the LAA at the time of mitral valve surgery. Indeed, the American College of Cardiology/American Heart Association guidelines for mitral valve surgery recommend the amputation of LAA at the time of operation to reduce the stroke risk.…”

mentioning

confidence: 99%

Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

et al. 2002

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“…The first reported cases of LAA exclusion in the surgical literature was in 1949, in two patients with recurrent arterial emboli [23]. Since that time, surgical ligation has fallen in and out of favor.…”

Section: Surgical Closurementioning

confidence: 99%

Left atrial appendage closure - Where are we now?

Sánchez¹,

Holmes²

2016

jshd

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Atrial fibrillation is the most common arrhythmia with significant morbidity and mortality. The most feared complication of atrial fibrillation remains stroke. While anticoagulation remains the cornerstone of stroke prevention in patients with atrial fibrillation, patients continue to be under treated due to misinformation, intolerance, as well as relative and absolute contraindications. The left atrial appendage has been implicated in thrombus formation in patients with atrial fibrillation. Left atrial appendage closure has been devised as an alternative strategy for decreasing stroke risk in patients with atrial fibrillation. Percutaneous left atrial appendage closure is currently being developed as a possible alternative to anticoagulation in patients at high risk for stroke especially among patients with relative or absolute contraindications to long-term anticoagulation. The PROTECT AF trials provides the first randomized, controlled trial data demonstrating proof of concept of left atrial appendage closure with the WATCHMAN device. Further data are explored in this review. Limited data are available with other devices. However, several devices are promising entries into the realm of left atrial appendage closure offering options to an under treated patient population.

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“…A suspicion has existed for many years that systemic embolism is linked with a large left atrial appendix in patients with rheumatic mitral valve disease (Madden, 1949). For this reason Bailey et al (1952) advised that it be amputated at mitral valvotomy.…”

mentioning

confidence: 99%

“…The operation designed to prevent further emboli consists of amputation of the appendix and correction when possible of the valve disease, even though it is trivial. Left atrial appendicectomy was recommended by Madden (1949), but he reported on only two cases, the results were not convincing, and he did not press home his argument.…”

mentioning

confidence: 99%

Systemic Embolism in Mitral Stenosis: Relation to the Size of the Left Atrial Appendix

Somerville¹,

Chambers²

1964

BMJ

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A suspicion has existed for many years that systemic embolism is linked with a large left atrial appendix in patients with rheumatic mitral valve disease (Madden, 1949 (Fig. 1) it was a reliable indicator of a large appendix. A concavity instead of a convexity usually meant a small appendix or the site of an appendix amputated at a previous valvotomy. The radiological assessment has fallacies: the bulge of a large appendix can be masked by cardiac enlargement, rotation, or displacement; a long serpentine appendix may not project on the left border of the heart; the curve of a large main pulmonary artery and its left descending branch may incorporate the appendix bulge. ResultsThe incidence of systemic embolism in mitral stenosis when the size of the left atrial appendix was small, medium, and large respectively is shown in Fig. 2

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Resection of the Left Auricular Appendix

Cited by 213 publications

References 6 publications

Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

Left atrial appendage closure - Where are we now?

Systemic Embolism in Mitral Stenosis: Relation to the Size of the Left Atrial Appendix

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