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Incidence and clinical relevance of left atrial appendage membranes: a new congenital heart disease?European Heart Journal. Cardiovascular... Apr 2022Left atrial appendage (LAA) membranes are rare congenital anomalies. Those involving the appendage orifice may obstruct its emptying flows, thus promoting blood stasis...
AIMS
Left atrial appendage (LAA) membranes are rare congenital anomalies. Those involving the appendage orifice may obstruct its emptying flows, thus promoting blood stasis and clot formation. However, the epidemiology of LAA membranes has never been studied and a correlation with appendage thrombosis has never been proved. Very few case reports described LAA membranes, therefore, their frequency and clinical significance are not known. Moreover, their presence and degree are of crucial importance in planning LAA percutaneous closure, a procedure whose indication is evolving, and whether their presence can represent technical issues during the device implantation is not known. This study aimed to evaluate the incidence and the clinical significance of LAA membranes.
METHODS AND RESULTS
A population of 6030 consecutive transoesophageal echo (TOE) studies has been retrospectively reviewed in order to find those patients in whom an LAA membrane has been found. A literature research has been performed to review previous described cases. Among 6030 TOE cases, an LAA membrane has been described in 6 (prevalence of 1/1000). In one case, the membrane was associated to a severe LAA hypoplasia and in another case to an LAA thrombus (these represent the first cases ever described). All patients had an atrial fibrillation (AF) history and two were in AF during the TOE exam.
CONCLUSION
LAA membranes are rare congenital abnormalities occasionally discovered during a TOE exam, frequently in patients affected by AF. In half of the cases, they obstruct the LAA flow, thus theoretically pre-disposing to clot formation. They may be rarely associated to an appendage hypoplasia. During a TOE exam, cardiac imagers should always rule out their presence.
Topics: Atrial Appendage; Atrial Fibrillation; Heart Defects, Congenital; Humans; Incidence; Retrospective Studies; Thrombosis
PubMed: 33948621
DOI: 10.1093/ehjci/jeab076 -
Clinical Anatomy (New York, N.Y.) Apr 2024Left atrial (LA) structures, including the accessory left atrial appendage (aLAA) and left atrial diverticulum, have been studied based on their prevalence, shape, and... (Meta-Analysis)
Meta-Analysis Review
Left atrial (LA) structures, including the accessory left atrial appendage (aLAA) and left atrial diverticulum, have been studied based on their prevalence, shape, and association with arrhythmia and thrombi formation. A pooled prevalence with morphometric data has not been determined in previous research. Our goal is to provide structured, clinically relevant information on said structures for clinical practitioners to use in their daily work. We propose that morphometric data of additional LA structures is necessary when considering the possible complications during cardiac interventions. We conducted a meta-analysis of all relevant studies which used electrocardiogram (ECG)-gated computed tomography (CT) imaging to determine the prevalence of LA structures and record their morphometric characteristics as well as the presence of thrombi. Data were extracted from 19 studies (n = 6643 hearts). The pooled prevalence estimate of left atrial diverticulum and/or aLAAs were reported from 14 studies and was 28.8%. The most common location noted was anterosuperior in the LA with 70.2% of structures found there. Data regarding thrombi presence in left atrial diverticulums or aLAAs were extracted from 11 studies and a thrombus was present in 0.2%. The prevalence rates of aLAAs and left atrial diverticulums are essential in performing uncomplicated cardiac interventions and reducing risk of electrophysiological procedures. Our findings show a considerable prevalence of LA structures in varying populations, provides information regarding the general characteristics of said structures, and does not support the previously theorized associated risk of thrombus formation in relation to LA structure presence.
Topics: Humans; Atrial Appendage; Atrial Fibrillation; Retrospective Studies; Thrombosis; Diverticulum
PubMed: 37621227
DOI: 10.1002/ca.24110 -
Veterinary Medicine and Science Sep 2023Three dogs were diagnosed with right atrial thrombosis, thought to be secondary to systemic diseases. Specifically, two cases had hyperadrenocorticism and one case was...
Three dogs were diagnosed with right atrial thrombosis, thought to be secondary to systemic diseases. Specifically, two cases had hyperadrenocorticism and one case was diagnosed with pancreatitis with acute renal injury. In all cases, the thrombi were found within the right atrium, necessitating a differentiation from cardiac neoplasia. In all three cases, the structures assumed to be thrombi had irregular margins with interspersed hypoechoic regions, which were later confirmed as thrombi based on the responsiveness to therapy. All three cases were prescribed with the combination of clopidogrel and rivaroxaban.The thrombi gradually disappeared after initiation of the combination therapy. Complete resolution of right atrial thrombosis was noted in each dog treated with clopidogrel and rivaroxaban. This combination therapy appears to be safe and well tolerated. Diligent observation of the echocardiographic findings and clinical course allows the diagnosis of thrombosis.
Topics: Dogs; Animals; Fibrinolytic Agents; Atrial Fibrillation; Rivaroxaban; Clopidogrel; Follow-Up Studies; Heart Diseases; Echocardiography; Heart Atria; Thrombosis; Dog Diseases
PubMed: 37491011
DOI: 10.1002/vms3.1210 -
Biomechanics and Modeling in... Aug 2023Hemodynamics play a vital role for the risk of thrombosis in the left atrial appendage (LAA) and left atrium (LA) for patients with atrial fibrillation. Accurate...
Computational modeling of hemodynamics and risk of thrombosis in the left atrial appendage using patient-specific blood viscosity and boundary conditions at the mitral valve.
Hemodynamics play a vital role for the risk of thrombosis in the left atrial appendage (LAA) and left atrium (LA) for patients with atrial fibrillation. Accurate prediction of hemodynamics in the LA can provide important guidance for assessing the risk of thrombosis in the LAA. Patient specificity is a crucial factor in representing the true hemodynamic fields. In this study, we investigated the effects of blood rheology (as a function of hematocrit and shear rate), as well as patient-specific mitral valve (MV) boundary conditions (MV area and velocity profiles measured by ultrasound) on the hemodynamics and thrombosis potential of the LAA. Four scenarios were setup with different degrees of patient specificity. Though using a constant blood viscosity can classify the thrombus and non-thrombus patients for all the hemodynamic indicators, the risk of thrombosis was underestimated for all patients compared with patient-specific viscosities. The results with least patient specificities showed that patients prone to thrombosis predicted by three hemodynamic indicators were inconsistent with clinical observations. Moreover, though patients had the same MV inlet flow rate, different MV models lead to different trends in the risk of thrombosis in different patients. We also found that endothelial cell activation potential and relative residence time can effectively distinguish thrombus and non-thrombus patients for all the scenarios, relatively insensitive to patient specificities. Overall, the findings of this study provide useful insights on patients-specific hemodynamic simulations of the LA.
Topics: Humans; Mitral Valve; Atrial Appendage; Blood Viscosity; Thrombosis; Atrial Fibrillation; Hemodynamics; Computer Simulation
PubMed: 37389735
DOI: 10.1007/s10237-023-01731-4 -
Current Cardiology Reviews 2021Right atrial thrombus can originate from distal venous sources or can be iatrogenic, secondary to the placement of central venous catheters, atrial devices, or... (Review)
Review
Right atrial thrombus can originate from distal venous sources or can be iatrogenic, secondary to the placement of central venous catheters, atrial devices, or surgeries. One of the most common complications of Central Venous Catheters (CVCs) is thromboembolism, which can be either fixed to the right atrium or can be free-floating. Device-related Right Atrial Thrombosis (RAT) can result in catheter occlusion, vascular occlusion, infection, and pulmonary embolism. The true incidence of these complications is unknown because the diagnosis may not be considered in asymptomatic patients, and it might be missed by Transthoracic Echocardiography (TTE). In this literature review, we discuss iatrogenic etiologies of RAT that is complicated by pulmonary embolism. We highlight the importance of maintaining a high index of suspicion of iatrogenic RAT, possible complications, and its management.
Topics: Heart Atria; Heart Diseases; Humans; Iatrogenic Disease; Pulmonary Embolism; Thromboembolism; Thrombosis
PubMed: 33238847
DOI: 10.2174/1573403X16999201124201632 -
Journal of the American Heart... Jun 2023Background Transesophageal echocardiography-guided direct cardioversion is recommended in patients who are inadequately anticoagulated due to perceived risk of left...
Background Transesophageal echocardiography-guided direct cardioversion is recommended in patients who are inadequately anticoagulated due to perceived risk of left atrial appendage thrombus (LAAT); however, LAAT risk factors remain poorly defined. Methods and Results We evaluated clinical and transthoracic echocardiographic parameters to predict LAAT risk in consecutive patients with atrial fibrillation (AF)/atrial flutter undergoing transesophageal echocardiography before cardioversion between 2002 and 2022. Regression analysis identified predictors of LAAT, combined to create the novel CLOTS-AF risk score (comprising clinical and echocardiographic LAAT predictors), which was developed in the derivation cohort (70%) and validated in the remaining 30%. A total of 1001 patients (mean age, 62±13 years; 25% women; left ventricular ejection fraction, 49.8±14%) underwent transesophageal echocardiography, with LAAT identified in 140 of 1001 patients (14%) and dense spontaneous echo contrast precluding cardioversion in a further 75 patients (7.5%). AF duration, AF rhythm, creatinine, stroke, diabetes, and echocardiographic parameters were univariate LAAT predictors; age, female sex, body mass index, anticoagulant type, and duration were not (all >0.05). CHADSVASc, though significant on univariate analysis (<0.001), was not significant after adjustment (=0.12). The novel CLOTS-AF risk model comprised significant multivariable predictors categorized and weighted according to clinically relevant thresholds (Creatinine >1.5 mg/dL, Left ventricular ejection fraction <50%, Overload (left atrial volume index >34 mL/m), Tricuspid Annular Plane Systolic Excursion (TAPSE) <17 mm, Stroke, and AF rhythm). The unweighted risk model had excellent predictive performance with an area under the curve of 0.820 (95% CI, 0.752-0.887). The weighted CLOTS-AF risk score maintained good predictive performance (AUC, 0.780) with an accuracy of 72%. Conclusions The incidence of LAAT or dense spontaneous echo contrast precluding cardioversion in patients with AF who are inadequately anticoagulated is 21%. Clinical and noninvasive echocardiographic parameters may identify patients at increased risk of LAAT better managed with a suitable period of anticoagulation before undertaking cardioversion.
Topics: Humans; Female; Middle Aged; Aged; Male; Atrial Appendage; Stroke Volume; Electric Countershock; Creatinine; Ventricular Function, Left; Heart Diseases; Thrombosis; Echocardiography, Transesophageal; Atrial Fibrillation; Risk Factors; Stroke
PubMed: 37301743
DOI: 10.1161/JAHA.122.029259 -
Computational and Mathematical Methods... 2022Atrial fibrillation (AF) is the most common heart rhythm disorder that has been shown to be associated with a significant increase in stroke and systemic embolism risk....
Left Atrial Appendage Depth and Tachycardia Bradycardia Syndrome as Important Predictors of Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation.
BACKGROUND
Atrial fibrillation (AF) is the most common heart rhythm disorder that has been shown to be associated with a significant increase in stroke and systemic embolism risk. The left atrial appendage (LAA) is a finger-like extension originating from the left atrium; the formation of thrombus in LAA is the main reason of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). This study is aimed at finding out the risk of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (NVAF).
METHOD
We retrospectively examined the clinic and left atrial computer tomography angiography (CTA) features of patients assessed in Zhengzhou No. 7 People's Hospital between January 2020 and January 2021 derivation. Student's -test, chi-square test, receiver operating characteristics (ROC) curves, and logistic regression analysis were used to identify predictors of LAAT.
RESULT
Of 480 patients included in the analysis, LAAT was found in approximately 9.2% of all patients. Univariate demographic predictors of LAAT included left atrium top and bottom diameter (LTD), left atrial appendage depth (LAAD), CHA2DS2-VASc, tachycardia bradycardia syndrome (TBS), and nonparoxysmal atrial fibrillation (PAF). In a multiple logistic regression analysis, the independent predictors of thrombus were LAAD > 23.45 mm (odds ratio: 4.216, 95% CI: 1.869-9.510, = 0.001), TBS (odds ratio: 4.076, 95% CI: 1.655-10.038, = 0.002), and non-PAF (odds ratio: 2.896, 95% CI: 1.183-7.094, = 0.02).
CONCLUSION
In NVAF patients with LAAT, evidence suggested that larger LAAD, non-PAF, and TBS present a high risk of LAAT. This is the first report demonstrating that the LAAD and TBS are associated with LAAT in patients with NVAF.
Topics: Atrial Appendage; Atrial Fibrillation; Bradycardia; Echocardiography, Transesophageal; Heart Diseases; Humans; Retrospective Studies; Risk Factors; Stroke; Tachycardia; Thrombosis
PubMed: 35401785
DOI: 10.1155/2022/4632823 -
Texas Heart Institute Journal Apr 2020Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis....
Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03-1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05-1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.
Topics: Aged; Atrial Appendage; Atrial Fibrillation; Cardiac Volume; Female; Heart Atria; Heart Diseases; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Thrombosis; Tomography, X-Ray Computed
PubMed: 32603460
DOI: 10.14503/THIJ-17-6290 -
Asian Cardiovascular & Thoracic Annals Nov 2020The left atrial appendage is thought to be responsible for the majority of embolic strokes, and has become an important target in the surgical management of atrial...
The left atrial appendage is thought to be responsible for the majority of embolic strokes, and has become an important target in the surgical management of atrial fibrillation. We present an original clip-and-loop technique using an AtriClip via a left minithoracotomy for post-stroke patients with atrial fibrillation. This procedure was performed in 43 cases between March 2018 and January 2020. No patient had a thrombus at the edge of the clip or communication into the left atrial appendage 3 months after surgery. Anticoagulant could be discontinued in all patients. Follow-up at 23 ± 10 months showed no recurrence of stroke.
Topics: Aged; Aged, 80 and over; Atrial Appendage; Atrial Fibrillation; Cardiac Surgical Procedures; Female; Humans; Ligation; Male; Middle Aged; Stroke; Surgical Instruments; Treatment Outcome
PubMed: 32856930
DOI: 10.1177/0218492320956456 -
European Heart Journal Sep 2022
Topics: Heart Atria; Humans; Pulmonary Embolism; Thrombosis
PubMed: 35751530
DOI: 10.1093/eurheartj/ehac346