Atrial Appendage
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2021 ◽  
Vol 71 ◽  
pp. 102905
Ibtissam Kissami ◽  
Ghizlane El Ouazzani ◽  
Mehdi El Bekkaoui ◽  
Imane Skiker ◽  
Nouha Elouafi ◽  

Giuseppe D´Ancona ◽  
Erdal Safak ◽  
Denise Weber ◽  
Fatih Arslan ◽  
Stephan Kische ◽  

2021 ◽  
Vol 8 ◽  
Bin-Feng Mo ◽  
Rui Zhang ◽  
Jia-Li Yuan ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  

Background: The aim of this study was to investigate the efficacy of left atrial appendage closure (LAAC) for primary and secondary stroke prevention in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF).Methods: This pilot study enrolled 36 patients with HCM and AF who underwent LAAC between April 2017 and December 2019, of whom 22 were for primary stroke prevention and 14 were for secondary prevention.Results: The patients enrolled in this study had non-obstructive (86.1%) or mild obstructive (13.9%) HCM. Patients in the Secondary Prevention Group had higher CHA2DS2-VASc scores (5.1 ± 1.4 vs. 2.6 ± 1.6, P < 0.001) and higher HAS-BLED scores (2.8 ± 1.0 vs. 1.5 ± 0.9, P < 0.001) compared with those in the Primary Prevention Group. Successful closure with satisfactory seals (residual leak ≤ 5 mm) was achieved in all patients, with complete occlusion in 86.4% of the Primary Prevention Group and 92.9% of the Secondary Prevention Group. Procedural-related complications included one pericardial effusion and one groin hematoma. One device-related thrombus was identified in the Secondary Prevention Group and resolved after anticoagulation. During a mean follow-up time of 28.4 months, one bleeding event was recorded. There were no thromboembolic events or deaths in either group, with 97.2% of the patients achieving freedom from anticoagulation therapy.Conclusions: Initial results suggest that LAAC can be a safe and feasible alternative for primary and secondary stroke prevention in selected patients with HCM and AF. Further studies with larger samples are required.

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Jia Yu ◽  
Yufeng Liu ◽  
Peng Sun ◽  
Xing Guo ◽  
Haiyang Jiang ◽  

Background and Objective. Thrombolytics and anticoagulants are conventional drugs for ischemic stroke (IS) treatment, whereas some patients have unfavorable responses to these drugs. The disease presents a relatively high recurrence rate. This investigation attempted to unveil the long-term effect of left atrial appendage occlusion (LAAO) in treating patients with previous IS on the disease recurrence. Methods. A total of 120 patients with IS admitted to Tangdu Hospital from July 2016 to September 2017 were grouped into the control group ( n = 60 ) and the observation group ( n = 60 ). Patients in the control group were only treated with thrombolytics and anticoagulants while those in the observation group were treated with both drugs and LAAO. Transesophageal echocardiography (TEE) was performed to observe the occlusion of LAA in patients in the observation group after 45 d and 6 months, respectively. Clinical outcomes in two groups were compared from the following aspects: recurrence of IS, incidence of systemic embolism, and the 3-year recurrence-free survival (RFS). The 3-year IS recurrence of patients was compared by Fisher’s exact test. Results. No significant differences were observed at baseline levels (age, sex, etc.) between the observation group and control group ( p > 0.05 ). During follow-up visit of 45 d and 6 months, all occluders met the efficacious occludsion criteria. The results of TEE at 45 d after LAAO showed that 50% of patients (30/60) in the observation group had complete occlusion of LAA. The results of TEE at 6 months after LAAO suggested that 58.3% of patients (35/60) had complete occlusion of LAA. IS recurrence in the observation group (3.33%, 2/60) was significantly lower than that in the control group (18.33%, 11/60), with the difference presenting statistical significance ( p = 0.008 ). Incidence of systemic embolism in the observation group (1.67%, 1/60) was markedly lower than that in the control group (13.33%, 11/60) ( p = 0.014 ). The average RFS in the observation group (31.97 months, 95% CI: 27.50~32.31 months) was notably longer than that in the control group (29.91 months, 95% CI: 29.85~32.92 months) ( p < 0.05 ). The 3-year IS recurrence of patients between two groups compared by Fisher’s exact test showed significant differences (1 year: p = 0.014 , 2 year: p = 0.008 , 3 year: p = 0.008 ). Conclusion. Regarding patients with previous IS who had poor response to thrombolytics and anticoagulants, LAAO could effectively decrease recurrence of IS and incidence of systemic embolism and prolong RFS of patients. LAAO was, therefore, an alternative for patients with high IS recurrence risk.

Cureus ◽  
2021 ◽  
Rajat Jain ◽  
Puneet Aggarwal ◽  
Mukesh J Jha ◽  
Bhagya Narayan Pandit ◽  
Preeti Gupta ◽  

Circulation ◽  
2021 ◽  
Vol 144 (14) ◽  
pp. 1088-1090
Subodh Verma ◽  
Deepak L. Bhatt ◽  
Elaine E. Tseng

Murtaza Ali Sundhu ◽  
Tayyab Ali Waheed ◽  
Usama Nasir ◽  
Rishin Handa ◽  
Rachel Dever ◽  

Kotaro Ouchi ◽  
Toru Sakuma ◽  
Takahiro Higuchi ◽  
Jun Yoshida ◽  
Ryosuke Narui ◽  

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Ahmed Mohamed Hassan ◽  
Hazem Mohamed Abdel Menaem ◽  
Ahmed Mohamed Onsy ◽  
Azza Alaa Omran ◽  
Mona Mostafa Mohamed Rayan

Abstract Background The most common etiology of stroke is known to be cardio- embolic type and left atrial appendage is the site of origin of thrombi in 90% of cardio embolic stroke .Most literature reports that left atrial appendage thrombi tend to be more common in females and black people1. In the past, the left atrial appendage (LAA) has been considered to be a relatively insignificant portion of cardiac anatomy. It is now recognized that it is a structure with important pathological associations as thrombus has a predilection to form within the LAA in patients with non-valvar atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm). The exact pathogenesis of thrombus formation inside left atrial appendage is still not fully elucidated, but many literature suppose that the cause is the stagnation within the long, blind-ended trabeculaed pouch2 Objective to describe left atrial appendage morphology and identify the prevalence of its different subtypes in Egyptian patients. Material and Methods the study analyzed retrospectively the data of 100 consecutive Egyptian patients who underwent multidetector computed tomography (MDCT) at Ain shams university specialized hospital from August 2019 to February 2020.Axial source images, two and threedimensional data sets were evaluated for each of the patients .All images were analyzed by a qualified cardiologist using dedicated software called “Horos Workstation”, and were blinded to patient data. All images were assessed and evaluated for LAA morphology and volume and were categorized according to the classification of Wang et al. 2010. Results windsock morphology existed in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of patients whereas 20% of patients had cactus morphology. There was significant gender difference in LAA morphology where female patients had more cauliflower and cactus morphology as compared to male gender (p &lt; 0.05). Left atrial appendage volume showed a statistically significant positive correlation with advanced age and significant negative correlation with Left ventricular ejection fraction. Conclusion Egyptian patients had predominantly windsock morphology in males and cactus morphology in females.

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