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European Journal of Heart Failure Aug 2021
Topics: Amyloidosis; Heart Atria; Heart Failure; Humans
PubMed: 34050585
DOI: 10.1002/ejhf.2257 -
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 -
International Journal For Numerical... Nov 2019We present a coupled left atrium-mitral valve model based on computed tomography scans with fibre-reinforced hyperelastic materials. Fluid-structure interaction is...
We present a coupled left atrium-mitral valve model based on computed tomography scans with fibre-reinforced hyperelastic materials. Fluid-structure interaction is realised by using an immersed boundary-finite element framework. Effects of pathological conditions, eg, mitral valve regurgitation and atrial fibrillation, and geometric and structural variations, namely, uniform vs non-uniform atrial wall thickness and rule-based vs atlas-based fibre architectures, on the system are investigated. We show that in the case of atrial fibrillation, pulmonary venous flow reversal at late diastole disappears, and the filling waves at the left atrial appendage orifice during systole have reduced magnitude. In the case of mitral regurgitation, a higher atrial pressure and disturbed flows are seen, especially during systole, when a large regurgitant jet can be found with the suppressed pulmonary venous flow. We also show that both the rule-based and atlas-based fibre defining methods lead to similar flow fields and atrial wall deformations. However, the changes in wall thickness from non-uniform to uniform tend to underestimate the atrial deformation. Using a uniform but thickened wall also lowers the overall strain level. The flow velocity within the left atrial appendage, which is important in terms of appendage thrombosis, increases with the thickness of the left atrial wall. Energy analysis shows that the kinetic and dissipation energies of the flow within the left atrium are altered differently by atrial fibrillation and mitral valve regurgitation, providing a useful indication of the atrial performance in pathological situations.
Topics: Atrial Fibrillation; Blood Flow Velocity; Finite Element Analysis; Heart Atria; Humans; Mitral Valve; Models, Cardiovascular; Tomography, X-Ray Computed
PubMed: 31454470
DOI: 10.1002/cnm.3254 -
Journal of Interventional Cardiac... Oct 2022Understanding of the atrial fibrillation (AF) driven by right atrial appendage (RAA) is limited. This study aimed to understand the characteristics of the AF driven by...
PURPOSE
Understanding of the atrial fibrillation (AF) driven by right atrial appendage (RAA) is limited. This study aimed to understand the characteristics of the AF driven by RAA and explore ablation methods.
METHODS
This was a retrospective study and patients who were identified as having the AF driven by RAA were reviewed. Ablation was performed during AF. Potential maps of the left and right atrium, electrophysiological examinations, and ablation methods were studied.
RESULTS
Among the 20 identified patients (mean age 67.0 ± 11.2 years; ejection fraction 62.9 ± 6.0%; LA diameter 43.1 ± 4.9 mm; RA diameter 51.7 ± 8.3 × 42.9 ± 3.7 mm), the AF cycle length in RAA (134.0 ± 10.9 ms) was the shortest, and the fastest frequency potentials were located in the RAA in 65% of patients. For the left atrium, the AF cycle length of the roof (145.5 ± 14.9 ms) was the shortest, followed by the left atrial appendage (153.7 ± 17.1 ms) and bottom (154.8 ± 11.8 ms). High-frequency potentials of RAA could be rapidly conducted to left atrium via sagittal bundle and Bachmann's bundle, and the conduction time (55.0 ± 5.0 ms) was significantly shorter than the mean bi-atrial activation time (176.7 ± 10.3 ms, P < 0.0001). AF could be terminated after ablation at the RAA base (17 patients) or mechanical stimulation within the RAA (3 patients). To date, only two patients had recurrent atrial flutter, while the remaining patients maintained sinus rhythm.
CONCLUSION
The AF driven by RAA is characterized by high-frequency potentials in RAA, and ablation at the RAA base can achieve a satisfactory therapeutic effect.
Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Flutter; Catheter Ablation; Heart Atria; Humans; Middle Aged; Retrospective Studies
PubMed: 35179671
DOI: 10.1007/s10840-021-01106-8 -
Archives of Iranian Medicine Oct 2022Persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein (LSPV) is a rare systemic venous drainage anomaly....
Persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein (LSPV) is a rare systemic venous drainage anomaly. It can cause cyanosis and unexplained recurrent strokes. Undiagnosed, it can seriously disrupt the conduct of the cardiopulmonary bypass (CPB), causing sudden air lock and/or flooding of the operative field with venous blood. Its connection with the LSPV outside the pericardium makes its intraoperative diagnosis difficult. We report here the case of a 48-year-old man operated for mitral and aortic valve endocarditis, complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by the entrance of high volume of air bubbles into the superior vena cava cannula which resulted in sudden air lock of the venous outflow line. After multiple lowerings and cessations of pump flow, partial clamping of this cannula resulted in flooding of the LA with venous blood coming from the LSPV. The heart luxation did not allow us to find the LSVC in its usual intrapericardial location, between the LSPV and the left appendage. We had to widely open the left pleura to expose its completely extrapericardial path and its communication with the LSPV. The LSVC was temporally clamped during the remainder of the surgical procedure, then ligated at both ends. The patient underwent mitral valve repair, closure of the infundibular septal defect, aortic valve replacement and tricuspid annuloplasty. He was discharged 10 days later.
Topics: Male; Humans; Middle Aged; Vena Cava, Superior; Pulmonary Veins; Heart Atria; Cardiopulmonary Bypass; Vascular Malformations
PubMed: 37542404
DOI: 10.34172/aim.2022.111 -
Brazilian Journal of Cardiovascular... Aug 2023A giant left atrium may cause respiratory dysfunction and hemodynamic disturbance postoperatively. This retrospective study aimed to evaluate clinical effects of...
INTRODUCTION
A giant left atrium may cause respiratory dysfunction and hemodynamic disturbance postoperatively. This retrospective study aimed to evaluate clinical effects of surgical left atrial reduction in concomitant cardiac valves operations.
METHODS
One hundred and thirty-five patients with heart valve diseases and giant left atriums from January 2004 to July 2021 were enrolled into this research. They were divided into the folded group (n=63) and the unfolded group (n=72). Patients in the folded group had undergone cardiac valve operations concomitantly with left atrial reductions. The perioperative characteristics were compared between both groups, and subgroup analysis was performed.
RESULTS
There were five deaths in the folded group and 25 deaths in the unfolded group (P<0.001). Complications including pneumonia, sepsis, multiple organs dysfunction syndrome, low cardiac output syndrome, and the use of continuous renal replacement therapy were significantly fewer in the folded group. The receiver operating characteristic curve of left atrial max. diameter predicting mortality was significant (area under the curve=0.878, P=0.005), and the cutoff point was 96.5 mm. The stratified analysis for sex showed that more female patients died in the unfolded group. Logistic regression for mortality showed that the left atrium unfolded, left atrial max. diameter, cardiopulmonary bypass time, and mechanical ventilation time increased the risk of death.
CONCLUSION
Surgical left atrial reduction concomitantly with valves replacement could decrease mortality and was safe and effective in giant left atrium patients.
Topics: Humans; Female; Mitral Valve; Atrial Fibrillation; Retrospective Studies; Heart Atria; Heart Valve Diseases; Cardiomegaly; Heart Valve Prosthesis Implantation
PubMed: 37540731
DOI: 10.21470/1678-9741-2022-0469 -
Thorax Mar 1970Radiographic evidence of asymmetrical enlargement of the left atrium without atrial infarction is presented. Giant atrial enlargement is rarely symmetrical, the atrial...
Radiographic evidence of asymmetrical enlargement of the left atrium without atrial infarction is presented. Giant atrial enlargement is rarely symmetrical, the atrial appendage can contribute to the enlargement, and the giant atrium can be effectively trimmed. This will reduce its size and, therefore, the space which it occupies, and will restore the anatomical relations of neighbouring structures such as the main bronchi.
Topics: Cardiac Catheterization; Cardiomegaly; Heart Atria; Humans; Mitral Valve Stenosis; Radiography
PubMed: 4245589
DOI: 10.1136/thx.25.2.190 -
JACC. Cardiovascular Imaging Jul 2015
Topics: Athletes; Heart Atria; Humans
PubMed: 26183550
DOI: 10.1016/j.jcmg.2014.12.031 -
TheScientificWorldJournal 2014Although often referred to as "the forgotten chamber", compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the... (Review)
Review
Although often referred to as "the forgotten chamber", compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Echocardiographers initially focused on early detection of atrial geometrical abnormalities through monodimensional atrial diameter quantification and then bidimensional (2D) areas and volume estimation. Now, together with conventional echocardiographic parameters, new echocardiographic techniques, such as strain Doppler, 2D speckle tracking and three-dimensional (3D) echocardiography, allow assessing early LA dysfunction and they all play a fundamental role to detect early functional remodelling before anatomical alterations occur. LA dysfunction and its important prognostic implications may be detected sooner by LA strain than by volumetric measurements.
Topics: Cardiovascular Diseases; Echocardiography; Heart Atria; Heart Ventricles; Humans; Patient Care
PubMed: 25009828
DOI: 10.1155/2014/451042 -
Journal of the American College of... Oct 2003
Topics: Biomarkers; Cardiovascular Diseases; Diastole; Echocardiography; Heart Atria; Humans; Risk Assessment
PubMed: 14522481
DOI: 10.1016/s0735-1097(03)00956-2