Congenital absence of left atrial appendage: A case report and literature review (original) (raw)
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Congenital Absence of Left Atrial Appendage Diagnosed by Multimodality Imaging
International heart journal, 2018
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected. An absence of the LAA was confirmed using cardiac computed tomography (CT), which included 3D reconstruction. Additionally, the LAA was not visualized with left atrium (LA) angiography. During the ablation procedure, 3D voltage mapping in LA was created and no low voltage area or abnormal potential was recorded around the usual root location of the LAA. Successful electrical pulmonary vein isolation was achieved with no major complications. After...
Circulation, 2010
Background— Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation. Methods and Results— Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71% nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation were enrolled. Two hundred sixty-six patients (27%) showed firing from the LAA and became the study population. In 86 of 987 patients (8.7%; 5 paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of arrhythmia with no pulmonary veins or other extrapulmonary vein site reconnection. Ablation was performed either with focal lesion (n=56; group 2) or to achieve LAA isolation by placement of the circular catheter at the ostium of the LAA guided by intracardiac echocardiogr...
Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation
2017
Accessible online at: http://structuralheartdisease.org/ Abstract Aims: Percutaneous left atrial appendage (LAA) occlusion has now become a suitable alternative to oral anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). However, LAA closure can be technically challenging and results suboptimal, in part due to variable left atrial anatomy.We aimed to characterize LAA morphology and identify potential anatomical pitfalls during LAA closure or LAA thrombus detection during transoesophageal echocardiography (TOE). Methods and Results: 103 patients with AF underwent cardiac magnetic resonance angiography to assess pulmonary venous anatomy. Adequate imaging quality was present in 76 in whom LAA morphology was assessed. The majority of LAAs (71%) were anterolaterally directed and 82% were ‘claw’-shaped. However, there was significant variation in anatomy and course in the remainder: 11% were anteverted, 9% laterally directed and 9% retroverted. The sh...
The Left Atrial Appendage: Anatomy, Function, and Noninvasive Evaluation
JACC: Cardiovascular Imaging, 2014
The left atrial appendage (LAA) is a finger-like extension originating from the main body of the left atrium. Atrial fibrillation (AF) is the most common clinically important cardiac arrhythmia, occurring in approximately 0.4% to 1% of the general population and increasing with age to >8% in those >80 years of age. In the presence of AF thrombus, formation often occurs within the LAA because of reduced contractility and stasis; thus, attention should be given to the LAA when evaluating and assessing patients with AF to determine the risk for cardioembolic complications. It is clinically important to understand LAA anatomy and function. It is also critical to choose the optimal imaging techniques to identify or exclude LAA thrombi in the setting of AF, before cardioversion, and with current and emerging transcatheter therapies, which include mitral balloon valvuloplasty, pulmonary vein isolation, MitraClip (Abbott Laboratories, Abbott Park, Illinois) valve repair, and the implantation of LAA occlusion and exclusion devices. In this review, we present the current data regarding LAA anatomy, LAA function, and LAA imaging using the currently available noninvasive imaging modalities.
Congenital Aneurysm of the Left Atrial Appendage with Left Superior Vena Cava
Clinical Medicine Insights: Therapeutics, 2011
A 32-year-old man underwent excision of an aneurysm of the left atrial appendage which had been causing palpitation and supraventricular tachyarrhythmia. Various techniques are useful for making the diagnosis and allowing differential diagnosis between this and other pathologies. In this report, the diagnosis was based on transthoracic and transesophageal echocardiography, and the patient was treated by surgical resection of the aneurysm on cardiopulmonary bypass. There were no postoperative complications. Four months later, the patient remained asymptomatic and in sinus rhythm.