Morphometric study of the left atrial appendage related to closure device deployment: a cadaveric study in Thai population
Abstract
Background: This study aims to investigate the left atrial appendage (LAA) regarding external morphology, positional relation of the ostium of LAA to the left superior pulmonary vein (LSPV), ostium shape, ostium diameter and functional depth. Materials and methods: Left atrial appendages of 65 cadaveric hearts were examined. Results: The prevalence of Cauliflower, Windsock, Cactus and Chicken wing type of LAA were 27.7%, 27.7%, 26.1%, and 18.5%, respectively. LAA with two lobes was the most common. All specimens showed no accessory LAA. The relation of the ostium to the LSPV was found in two types which were mid-type (LAA ostium was at the same level as LSPV) in 29 (44.6%) cases and inferior type (LAA ostium was below the level of LSPV) in 36 (55.4%) cases. The shapes of LAA ostium were oval and round with a prevalence of 55.4% and 44.6%, respectively. The diameter of round type ranged from 9.53 to 21.51 mm with a mean of 14.56 ± 2.6 mm. While in oval type, the long and short diameters ranged from 11.61 to 31.71 mm with a mean of 14.23 ± 4.2 mm and from 6.70 to 23.90 mm with a mean of 11.66 ± 3.5 mm, respectively. The Surface area of the ostium was calculated from the ostium diameter, range from 71.29 to 594.92 mm2 with a mean of 169.56 ± 84.73 mm2. There was no statistically significant difference of the surface area between LAA types. The mean functional depth of LAA was 11.57 ± 4.43 mm. The functional depth of the Windsock-type appeared to be statistically significant from the others. However, there was no correlation between the functional depth and the ostium surface area. Conclusions: This morphometric data might be beneficial for deployment of LAA closure device in the Thai population.
Keywords: left atrial appendage (LAA)functional depth of LAALAA closureleft superior pulmonary veinostium diameterostium shapeostium surface area
References
- Di Biase L, Santangeli P, Anselmino M, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012; 60(6): 531–538.
- Fountain RB, Holmes DR, Chandrasekaran K, et al. The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial. Am Heart J. 2006; 151(5): 956–961.
- Fukushima K, Fukushima N, Kato K, et al. Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016; 17(1): 59–66.
- Glassy MS, Sharma G, Singh GD, et al. Usable implantation depth for watchman left atrial appendage occlusion is greater with appendage angiography than transesophageal echocardiography. Catheter Cardiovasc Interv. 2019; 93(5): E311–E317.
- Kamiński R, Kosiński A, Brala M, et al. Variability of the Left Atrial Appendage in Human Hearts. PLoS One. 2015; 10(11): e0141901.
- Khurram IM, Dewire J, Mager M, et al. Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation. Heart Rhythm. 2013; 10(12): 1843–1849.
- Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. Heart Rhythm. 2013; 10(6): 921–925.
- Kong B, Liu Yu, Hu He, et al. Left atrial appendage morphology in patients with atrial fibrillation in China: implications for stroke risk assessment from a single center study. Chin Med J (Engl). 2014; 127(24): 4210–4214.
- Lee JM, Seo J, Uhm JS, et al. Why Is Left Atrial Appendage Morphology Related to Strokes? An Analysis of the Flow Velocity and Orifice Size of the Left Atrial Appendage. J Cardiovasc Electrophysiol. 2015; 26(9): 922–927.
- Lip GYH, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol. 2007; 6(11): 981–993.
- López-Mínguez JR, González-Fernández R, Fernández-Vegas C, et al. Anatomical classification of left atrial appendages in specimens applicable to CT imaging techniques for implantation of amplatzer cardiac plug. J Cardiovasc Electrophysiol. 2014; 25(9): 976–984.
- Moussa Pacha H, Al-Khadra Y, Soud M, et al. Percutaneous devices for left atrial appendage occlusion: A contemporary review. World J Cardiol. 2019; 11(2): 57–70.
- Nedios S, Koutalas E, Kornej J, et al. Cardiogenic stroke despite low CHA-DS-VASc score: assessing stroke risk by left atrial appendage anatomy (ASK LAA). J Cardiovasc Electrophysiol. 2015; 26(9): 915–921.
- Petersen M, Roehrich A, Balzer J, et al. Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation. Europace. 2015; 17(4): 539–545.
- Phrommintikul A, Detnuntarat P, Prasertwitayakij N, et al. Prevalence of atrial fibrillation in Thai elderly. J Geriatr Cardiol. 2016; 13(3): 270–273.
- Reddy VY, Holmes D, Doshi SK, et al. Safety of percutaneous left atrial appendage closure: results from the watchman left atrial appendage system for embolic protection in patients with AF (PROTECT AF) clinical trial and the continued access registry. Circulation. 2011; 123(4): 417–424.
- Song H, Zhou Q, Zhang L, et al. Evaluating the morphology of the left atrial appendage by a transesophageal echocardiographic 3-dimensional printed model. Medicine (Baltimore). 2017; 96(38): e7865.
- Su P, McCarthy KP, Ho SY. Occluding the left atrial appendage: anatomical considerations. Heart. 2008; 94(9): 1166–1170.
- Suradi HS, Hijazi ZM. Left atrial appendage closure: outcomes and challenges. Neth Heart J. 2017; 25(2): 143–151.
- Üçerler H, İkiz ZA, Özgür T. Human left atrial appendage anatomy and overview of its clinical significance. Anadolu Kardiyol Derg. 2013; 13(6): 566–572.
- Vargas-Barrón J, Espinola-Zavaleta N, Roldán FJ, et al. Transesophageal echocardiographic diagnosis of thrombus in accessory lobes of the left atrial appendage. Echocardiography. 2000; 17(7): 689–691.
- Veinot JP, Harrity PJ, Gentile F, et al. Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination. Circulation. 1997; 96(9): 3112–3115.
- Viles-Gonzalez JF, Kar S, Douglas P, et al. The clinical impact of incomplete left atrial appendage closure with the Watchman Device in patients with atrial fibrillation: a PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) substudy. J Am Coll Cardiol. 2012; 59(10): 923–929.
- Waksman R, Pendyala LK. Overview of the Food and Drug Administration circulatory system devices panel meetings on WATCHMAN left atrial appendage closure therapy. Am J Cardiol. 2015; 115(3): 378–384.
- Wang Y, Di Biase L, Horton RP, et al. Left atrial appendage studied by computed tomography to help planning for appendage closure device placement. J Cardiovasc Electrophysiol. 2010; 21(9): 973–982.
- Yamamoto M, Seo Y, Kawamatsu N, et al. Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging. 2014; 7(2): 337–343.
- Yamashita T. Virchow triad and beyond in atrial fibrillation. Heart Rhythm. 2016; 13(12): 2377–2378.
- Yeow WL, Kar S. Device- and laa-specific characteristics for successful LAA closure: tips and tricks. Interv Cardiol Clin. 2014; 3(2): 239–254.
- Zhang J, Cui CY, Huang DQ, et al. Evaluation of the left atrial appendage by real time three-dimensional transesophageal echocardiography online. Echocardiography. 2018; 35(7): 991–998.
