Morphometrical features of left atrial appendage in the atrial fibrillation patients subjected to left atrial appendage closure

Słodowska, Katarzyna; Batko, Jakub; Hołda, Jakub; Dudkiewicz, Damian; Koziej, Mateusz; Litwinowicz, Radosław; Bartus, K; Hołda, Mateusz K.

doi:10.5603/fm.a2022.0080

Cited by 9 publications

(10 citation statements)

References 23 publications

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“…Currently, LAAO has become a standard procedure performed in hybrid operating rooms or catheterization laboratories[ 2 ]. Despite the procedure’s prevalence, LAAO itself is technically demanding, requiring the operator’s precise mastery of cardiac structural anatomy, while the LAA itself exhibits diverse anatomy and delicate, thin-walled musculature [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of method used, safety and effectiveness of the procedure strongly rely on presurgical imaging showing the local topography, which is common for all types of cardiac surgery [ 11 , 12 ]. What is also important during left atrial appendage procedures is its anatomy regarding differences in structure of the LAA in patients with atrial fibrillation [ 9 , 13 ]. In patients with AF the LAA is significantly larger but the precise mechanism of remodeling is yet to be discovered [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…What is also important during left atrial appendage procedures is its anatomy regarding differences in structure of the LAA in patients with atrial fibrillation [ 9 , 13 ]. In patients with AF the LAA is significantly larger but the precise mechanism of remodeling is yet to be discovered [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Burysz,

Batko,

Malec-Litwinowicz

et al. 2024

kitp

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Introduction Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game-changer in transcatheter interventions. Aim This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions. Material and methods We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months. Results A cohort of 83 patients (mean age: 72.1 ±8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 ±34.3 min, contrast medium usage averaged 33.7 ±22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 ±3.4 days. Adverse effects were rare, including minimal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates. Conclusions This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Burysz,

Batko,

Malec-Litwinowicz

et al. 2024

kitp

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“…Although the LAA anatomy appears thoroughly known (Dudkiewicz et al, 2021; Roberts et al, 2019; Slodowska et al, 2022; Słodowska, Hołda, et al, 2021; Słodowska, Szczepanek, et al, 2021), the LAA neck has not been well defined or explored. The growing clinical importance of the LAA as a common source of thrombus formation and the introduction of various LAA exclusion techniques into daily clinical practice forced us to provide a detailed morphological description of the most proximal part of the LAA—the neck region (Naksuk et al, 2016; Słodowska, Szczepanek, et al, 2021; Whiteman et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…It has been described as a region where occluding devices are placed, a junction between the orifice, landing zone, and lobar region (Beigel et al, 2014; Grygier et al, 2018; Naksuk et al, 2016). The term “LAA neck” has also been mentioned in a few recent anatomical publications without clearly defining this structure (Slodowska et al, 2022; Whiteman et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Definition and anatomical description of the left atrial appendage neck

Batko,

Jakiel,

Krawczyk–Ożóg

et al. 2023

Clinical Anatomy

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The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three‐dimensional reconstructions of the heart chambers based on contrast‐enhanced electrocardiography–gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone‐shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2. The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three‐dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.

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Anatomical description of malformations of the neck of the left atrial appendage

Batko,

Jakiel,

Krawczyk–Ożóg

et al. 2024

Clinical Anatomy

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The recently‐described left atrial appendage (LAA) neck is a truncated cone‐shaped structure that connects the LAA orifice to its lobe. It shows malformations in some cases, but their exact description and clinical significance are unknown. Therefore, the aim of this study was to provide a detailed anatomical and morphometric analysis of LAA neck malformations in clinical context. A total of 250 autopsied human hearts (20.0% women, 46.7 ± 18.2 years old) were examined for mural malformations: spikes and bulges. Endocardial roughness of the LAA neck with a depth <2 mm and no recognizable epicardial protrusion was defined as ectopic trabeculation. LAA neck malformations were found in 13.6%, bulges in 10.0% of the hearts examined, spikes in only 3.2%, and ectopic trabeculations in 24.8%. In one case, both a bulge and a spike were found in the LAA neck. Most LAA neck roughness was observed on the aortic and venous surfaces of the LAA neck. Those surfaces were the most common locations for malformations and ectopic trabeculations. The LAA wall was significantly thinner than the surrounding neck wall within the bulges and the ectopic trabeculations, but not in the spikes.

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Morphometrical features of left atrial appendage in the atrial fibrillation patients subjected to left atrial appendage closure

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Folia Morphologica" are listed in PubMed.

Cited by 9 publications

References 23 publications

Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Combining echocardiography and fluoroscopy imaging in real time for left atrial appendage occlusion – single center experience from Poland

Definition and anatomical description of the left atrial appendage neck

Anatomical description of malformations of the neck of the left atrial appendage

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