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 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 B-PO02-149 INCIDENCE, PREDICTORS, AND NATURAL HISTORY OF LEFT ATRIAL APPENDAGE THROMBI IN TRANSTHYRETIN CARDIAC AMYLOIDOSIS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S158
Author(s):  
Eoin Donnellan ◽  
Oussama M. Wazni ◽  
Walid I. Saliba ◽  
Divyang Rajesh Patel ◽  
Jeffrey Hedley ◽  
...  
Keyword(s):  
Natural History ◽  
Left Atrial ◽  
Cardiac Amyloidosis ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

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 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.

Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Chung ◽  
Gordon Ho ◽  
Andrew Schluchter ◽  
Francisco Contijoch ◽  
Jonathan C Hsu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Ct Scan ◽  
Blood Volume ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

Abstract 18516: Regional Dysfunction of Left Atrial Appendage and its Association with Stroke in Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Abdullah A Alissa ◽  
Yuko Inoue ◽  
Jochen Cammin ◽  
Qiulin Tang ◽  
Elliot Fishman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Control Group ◽  
Prior History ◽  
Area Change ◽  
Increased Risk ◽  
History Of ◽  
Regional Dysfunction

Background: Atrial Fibrillation (AF) is associated with an increased risk of cardioembolic stroke. Previous studies demonstrate that the Left atrial appendage (LAA) is the most common site of intracardiac thrombus, and the LAA morphology alone may determine the risk of stroke. We aimed to determine the association between LAA regional dysfunction using novel, noninvasive, image-based motion-estimation CT (iME) and prior history of stroke in patients with AF. Methods: Among the patients with history of AF referred for ablation who underwent pre-ablation CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA, and 18 age- and gender-matched controls. The patients in AF at the time of CT were excluded. Four-dimensional motion vector field was estimated from reconstructed CT images using iME at every 5% RR interval. To assess myocardial deformation, area change ratio and area change rate were calculated over the endocardial surface of the LA and LAA. Univariate and multivariate comparisons were made by using binary logistic regression model. Results: A total of 36 patients (mean age 67.6 ± 8.1 years, 66.7% male, 16.7% persistent AF) were included in the study. Univariate analysis showed that the LA pre-atrial contraction area change ratio and LAA maximum area change ratio were significantly lower (P= 0.02 and 0.04, respectively) in the stroke/TIA group compared to the control group. These changes remained statistically significant in multivariate analysis (P=0.03 and 0.04, respectively) after adjusting for age, sex, body mass index, LV ejection fraction, type of AF, and CHADS score. Conclusions: LAA regional dysfunction is associated with stroke/TIA in patients with AF. LAA regional dysfunction detected by iME could represent a marker for stroke and a possible therapeutic target.

Abstract 16058: Abnormal P Wave Morphology is Associated With Decreased Left Atrial Appendage Ejection Velocity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nathaniel D Mcconkey ◽  
Peter Malamas ◽  
Jovan Plamenac ◽  
Robert Park ◽  
Frank Weigel ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
P Wave ◽  
Atrial Appendage ◽  
Volume Index ◽  
Complex Congenital Heart Disease ◽  
Ejection Velocity ◽  
Odds Ratios ◽  
History Of

Introduction: P-wave abnormalities measured during periods of sinus rhythm have been associated stroke in people with atrial fibrillation (AF). The majority of AF-related strokes occur from left atrial appendage (LAA) thromboembolism. Electrical and mechanical dysfunction of the left atrium (LA) and left atrial appendage (LAA) can lower the threshold for thromboembolism and stroke. Hypothesis: We aimed to determine whether P-wave abnormalities are associated with decreased LAA ejection velocity (LAAV) on transesophageal echocardiography (TEE). Methods: We conducted a retrospective cross-sectional study. We reviewed patients at a tertiary care medical center who had underwent TEE in sinus rhythm and had an interpretable sinus rhythm ECG within 12 months of TEE. Participants were excluded for history of complex congenital heart disease, age<18, cardiac transplantation, and atrial pacing. Logistic regression analysis was used to estimate the odds ratios of LAAV<40 cm/s for P-wave abnormalities—advanced interatrial block (aIAB), abnormal P-wave terminal force in V1 (aPTFV1), prolonged P-wave duration (PPWD), and abnormal P-wave axis (aPWA). Results: In our final cohort of 169 patients, the odds ratios of aIAB and aPTFV1 for LAAV<40 cm/s after adjustment for CHA 2 DS 2 VASc variables, heart rate during TEE, history of atrial arrhythmias, and left atrial volume index were 2.81 (1.07-7.53) and 2.48 (1.13-5.60), respectively. Conclusions: P-wave abnormalities are independently associated with low LAAV, which may explain their association with AF-related stroke. Further research is needed to determine if incorporation of P-wave analysis will aid AF-related stroke prediction algorithms.

Impact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG

2021 ◽  
Author(s):  
Muhammed Gerçek ◽  
Mina Ghabrial ◽  
Lina Glaubitz ◽  
Oliver Kuss ◽  
Anas Aboud ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Atrial Appendage ◽  
Control Group ◽  
Preoperative Risk ◽  
Off Pump ◽  
History Of ◽  
Pump Cabg

Abstract Objectives Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA. Methods Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias. Results A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], p = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], p = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly (p = 0.18, 95% CI [−0.29; 1.51]). Conclusion Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.

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