scholarly journals 1112 Discovering the origin of a mysterious heart cavity

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Vidal Urrutia ◽  
P Garcia Gonzalez ◽  
J L Perez Bosca ◽  
D Escribano Alarcon ◽  
J M Simon Machi ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Contrast Echocardiography ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Invasive Approach ◽  
Cardiovascular Morbidity And Mortality ◽  
Doppler Color

Abstract Left atrial appendage aneurysm is an infrequent cardiac malformation, with less than 150 cases reported in the literature. It is a congenital anomaly in the majority of cases, related to a dysplasia of pectinate muscles and atrial muscle bands, which tends to grow with age. At the present time, and despite of being not considered in current guidelines, surgical resection is the standard of treatment in the current literature, even in asymptomatic cases, based on cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia, thromboembolism, and other rare conditions as coronary or left ventricular compression and rupture of the aneurysm. We report the case of a 53-year-old male patient presenting an episode of supraventricular paroxysmal tachycardia with the casual finding of a mysterious cavity in the transthoracic echocardiography. We found out the presence of a 50 mm cavity adjacent to the left atrium and left ventricle, with a bidirectional blood flow between the left atrium and the cavity when applying Doppler color and with contrast echocardiography. Given this finding, several differential diagnosis had to be considered, including vascular and structural disorders. In order to clarify the diagnosis, a cardiac magnetic resonance was performed. It revealed the presence of a huge aneurysm of the left atrial appendage (50 x 53 mm) causing a mild compression of the left ventricle, with no thrombus and no other significant findings. Due to its size, the compression of the left ventricle and the history of atrial arrhythmia we decided to manage it with an invasive approach by performing a middle thoracotomy, in order to prevent potentially serious complications. Abstract 1112 Figure. CMR 3D reconstruction; echocardiography

scholarly journals Natural History of Intra-cardiac Thrombus in Stroke/TIA Patients

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 377-377
Author(s):  
Souvik Sen ◽  
Somchai Laowatana ◽  
Stephen M Oppenheimer
Keyword(s):  
Natural History ◽  
Left Ventricle ◽  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Cerebrovascular Event ◽  
Intracardiac Thrombus ◽  
Cardiac Thrombus ◽  
History Of

P209 Background Intra-cardiac thrombus is a potential source of embolus leading to ischemic cerebrovascular event. The natural history of intra-cardiac thrombus is not known. Objectives To examine the natural history of intra-cardiac thrombus detected by TEE in stroke/TIA patients. Methods Eighty-one patients with recent stroke/TIA underwent sequential TEE evaluations at ≤7 days and 9 months from the symptom onset to detect intra-cardiac thrombus (mean age 60, 39 males and 60 black). The TEEs were recorded on VHS videotape and systematically evaluated by two blinded cardiologists for evidence and location of intra-cardiac thrombus (λ=0.72). In case of a disagreement it was adjudicated by a third blinded cardiologist. The stroke risk factors and stroke preventive medications were recorded in patients with and without intracardiac thrombus and compared using χ 2 test. Results An intra-cardiac thrombus was found in the initial TEE in 18 (22%) patients (2 in left atrium, 13 in left atrial appendage, 3 in left ventricle) and in the follow-up 9 month TEE in 9 (11%) patients (8 in left atrial appendage, 1 in left ventricle). The intracardiac thrombus had disappeared in 14 (78%) patients in a period of 9 months (2 in left atrium, 9 in left atrial appendage and 3 in left ventricle). Disappearance of intracardiac thrombus correlated strongly with patients anticoagulated with Warfarin (p<0.0001). A new intracardiac thrombus was detected only on the 9 month TEE in 5 (6%) patients (5 in the left atrial appendage, none in the left atrium or left ventricle). The patients with new intracardiac thrombus were significantly (p=0.02) older (mean±SD=70±7 yrs) as compared to those without (59±12 yrs). Three out of five patients with new cardiac thrombus were felt to have small vessel occlusive disease and were on antiplatelet therapy. Conclusions Anticoagulation with warfarin for 9 months can result in disappearance of intracardiac thrombus in stroke/TIA patients. Anticoagulation with Warfarin may have a therapeutic role in stroke/TIA patients with intracardiac thrombus. Older patients with lacunar strokes and not on anticoagulation are prone to develop an new intracardiac thrombus.

scholarly journals Rare accessory pathway between a giant left atrial appendage and the left ventricle

2020 ◽  
Vol 6 (3) ◽  
pp. 131-134
Author(s):  
Misugi Emi ◽  
Hisaaki Aoki ◽  
Yoshihide Nakamura ◽  
Yasuhiro Hirano ◽  
Kunihiko Takahashi ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Accessory Pathway ◽  
Atrial Appendage

scholarly journals Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Chen ◽  
Changjiang Xu ◽  
Wensu Chen ◽  
Chaoqun Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Flow Velocity ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Linear Regression Analysis ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Mechanical Function ◽  
Orifice Area ◽  
The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = −  0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

scholarly journals Does left atrial appendage occlusion influence left atrial hemodynamics? Pilot results of invasive intra-cardiac measurements

2021 ◽  
Author(s):  
Samuel Heuts ◽  
John Heijmans ◽  
Mark La Meir ◽  
Bart Maesen
Keyword(s):  
Pilot Study ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Systemic Arterial Pressure ◽  
Left Ventricular ◽  
Hemodynamic Effect ◽  
Atrial Appendage ◽  
Central Venous ◽  
Left Atrial Appendage Occlusion ◽  
Laa Closure

Introduction Although left atrial appendage (LAA) obliteration is the cornerstone of stroke prevention in surgical treatment of atrial fibrillation (AF), little is known about its direct impact on hemodynamics. In the current pilot study, we evaluated the hemodynamic effect of LAA closure by clipping in patients undergoing hybrid AF ablation. Methods Seven patients with paroxysmal or persistent AF were included. Hemodynamic and intracardiac pressure measurements such as systemic, pulmonary artery (PA), central venous and LA pressure, cardiac output and indexed left ventricular stroke volume (LVSVi) were measured directly before (T0) and after (T1), and 10 minutes after (T2) LAA closure. Results Of the 7 patients (median 66 yrs), 5 were in AF at the time of incision. There were no differences between T0 and T1, T1 and T2 and T0 and T2 for LA pressure, mean PA pressure, LVSVi and other hemodynamic parameters such as central venous oxygenation and pressure, or systemic arterial pressure. Conclusion In this pilot study, the direct hemodynamic effect of LAA closure is evaluated for the first time. Clipping of the LAA is safe and does not directly affect hemodynamic and intracardiac pressures.

scholarly journals Effect of the Alterations in Contractility and Morphology Produced by Atrial Fibrillation on the Thrombosis Potential of the Left Atrial Appendage

2021 ◽  
Vol 9 ◽  
Author(s):  
Danila Vella ◽  
Alessandra Monteleone ◽  
Giulio Musotto ◽  
Giorgia Maria Bosi ◽  
Gaetano Burriesci
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Fluid Dynamic ◽  
Atrial Appendage ◽  
Primary Role ◽  
Shear Strain Rate ◽  
Increased Risk

Atrial fibrillation (AF) is a common arrhythmia mainly affecting the elderly population, which can lead to serious complications such as stroke, ischaemic attack and vascular dementia. These problems are caused by thrombi which mostly originate in the left atrial appendage (LAA), a small muscular sac protruding from left atrium. The abnormal heart rhythm associated with AF results in alterations in the heart muscle contractions and in some reshaping of the cardiac chambers. This study aims to verify if and how these physiological changes can establish hemodynamic conditions in the LAA promoting thrombus formation, by means of computational fluid dynamic (CFD) analyses. In particular, sinus and fibrillation contractility was replicated by applying wall velocity/motion to models based on healthy and dilated idealized shapes of the left atrium with a common LAA morphology. The models were analyzed and compared in terms of shear strain rate (SSR) and vorticity, which are hemodynamic parameters directly associated with thrombogenicity. The study clearly indicates that the alterations in contractility and morphology associated with AF pathologies play a primary role in establishing hemodynamic conditions which promote higher incidence of ischaemic events, consistently with the clinical evidence. In particular, in the analyzed models, the impairment in contractility determined a decrease in SSR of about 50%, whilst the chamber pathological dilatation contributed to a 30% reduction, indicating increased risk of clot formation. The equivalent rigid wall model was characterized by SSR values about one order of magnitude smaller than in the contractile models, and substantially different vortical behavior, suggesting that analyses based on rigid chambers, although common in the literature, are inadequate to provide realistic results on the LAA hemodynamics.

Pericardial Patch Exclusion Technique for Left Atrial Appendage Closure

2018 ◽  
Vol 13 (2) ◽  
pp. 144-146
Author(s):  
Olivia K. Ginty ◽  
Ferns H. Khaliel ◽  
Corey Adams ◽  
Michael W. A. Chu
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Pericardial Patch ◽  
Left Atrial Appendage Closure ◽  
Risk Of Bleeding ◽  
Left Atrial Appendage Occlusion ◽  
Autologous Pericardial Patch ◽  
Patch Closure

We describe a technique of left atrial appendage occlusion that consists of autologous pericardial patch closure of the left atrial appendage orifice from within the left atrium. This pericardial patch exclusion technique has little added risk of bleeding, can be performed through sternotomy or right minithoracotomy, and can be used in re-operative situations.

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