During development the human cortex changes from a smooth lissencephalic structure to one that is highly convoluted. Increases in the degree of cortical folding are associated with brain size only for the first part of brain growth; during the second half, differences in cortical folding match those of brain size, resulting in no change in the degree of folding. When the degree of cortical folding is studied as a function of age, a brief postnatal overshoot, an effect of brain size, is observed. The analysis suggests that the mechanical hypothesis of cortical buckling can best explain the degree of cortical folding, but that other hypotheses, like gyrogenesis, are required to explain the placement and orientation of sulci. The adult asymptote in degree of cortical folding is associated with the onset and disappearance of single subplate lamina, suggesting that subplate:cortical plate associations should be examined as causal for gyrification. Areas whose sulci differ in length between the two hemispheres have similar degrees of convolutedness, supporting interpretations that the sizes of gyri are asymmetric in the two hemispheres. The ontogenetic data support the thesis that human cortical proportions evolved when the brain enlarged in size and that the process was not one of neoteny.

In this multicentre study, LAAO with the ACP showed high procedural success and a favourable outcome for the prevention of AF-related thromboembolism. Modification in antithrombotic therapy after LAAO may result in reduction of bleeding events.

Background-Thromboembolism due to atrial fibrillation (AF) is a frequent cause of stroke. More than 90% of thrombi in AF form in the left atrial appendage (LAA). Obliteration of the appendage may prevent embolic complications. Methods and Results-We evaluated the feasibility and safety of implanting a novel device for percutaneous left atrial appendage transcatheter occlusion (PLAATO). LAA occlusion using the PLAATO system was attempted in 15 patients with chronic AF at high risk for stroke, who are poor candidates for long-term warfarin therapy. The implant consists of a self-expanding nitinol cage covered with a polymeric membrane (ePTFE). The LAA was successfully occluded in 15/15 patients (100%). Angiography and transesophageal echocardiography (TEE) during the procedure showed that the device was well-seated in all patients and that there was no evidence of perforation, device embolization, or interference with surrounding structures. In 1 patient, the first procedure was complicated by a hemopericardium, which occurred during LAA access. A second attempt 30 days later was successful with no untoward sequela. No other complications occurred. At 1-month follow-up, chest fluoroscopy and TEE revealed continued stable implant position with smooth atrial-facing surface and no evidence of thrombus. Conclusions-Thus, transcatheter closure of the LAA is feasible in humans. This novel implant technology may be appropriate for patients with AF who are not suitable candidates for anticoagulation therapy. Further trials are needed to show the long-term safety and its efficacy in reducing stroke.