Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Folia Morphologica
MENU
Shortcuts Submit an article Author Guidelines (new) Ahead Of Print Reviewers 2023

open access

Vol 79, No 1 (2020)
Original article
Submitted: 2019-04-02
Accepted: 2019-05-22
Published online: 2019-05-28
View PDF Download PDF file
Get Citation

Morphometric study of the left atrial appendage related to closure device deployment: a cadaveric study in Thai population

M. Panyawongkhanti1, P. Fuktongphan1, V. Chentanez2
DOI: 10.5603/FM.a2019.0066
·
Pubmed: 31162625
·
Folia Morphol 2020;79(1):79-85.
Affiliations
  1. Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  2. Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

open access

Vol 79, No 1 (2020)
ORIGINAL ARTICLES
Submitted: 2019-04-02
Accepted: 2019-05-22
Published online: 2019-05-28

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.

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.

Full Text:

View PDF Download PDF file
Get Citation

Keywords

left atrial appendage (LAA), functional depth of LAA, LAA closure, left superior pulmonary vein, ostium diameter, ostium shape, ostium surface area

About this article
Title

Morphometric study of the left atrial appendage related to closure device deployment: a cadaveric study in Thai population

Journal

Folia Morphologica

Issue

Vol 79, No 1 (2020)

Article type

Original article

Pages

79-85

Published online

2019-05-28

Page views

2186

Article views/downloads

653

DOI

10.5603/FM.a2019.0066

Pubmed

31162625

Bibliographic record

Folia Morphol 2020;79(1):79-85.

Keywords

left atrial appendage (LAA)
functional depth of LAA
LAA closure
left superior pulmonary vein
ostium diameter
ostium shape
ostium surface area

Authors

M. Panyawongkhanti
P. Fuktongphan
V. Chentanez

References (29)
  1. 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.
    CrossRefPubMed
  2. 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.
    CrossRefPubMed
  3. 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.
    CrossRefPubMed
  4. 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.
    CrossRefPubMed
  5. Kamiński R, Kosiński A, Brala M, et al. Variability of the Left Atrial Appendage in Human Hearts. PLoS One. 2015; 10(11): e0141901.
    CrossRefPubMed
  6. 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.
    CrossRefPubMed
  7. 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.
    CrossRefPubMed
  8. 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.
    PubMed
  9. 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.
    CrossRefPubMed
  10. Lip GYH, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol. 2007; 6(11): 981–993.
    CrossRefPubMed
  11. 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.
    CrossRefPubMed
  12. 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.
    CrossRefPubMed
  13. 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.
    CrossRefPubMed
  14. 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.
    CrossRefPubMed
  15. Phrommintikul A, Detnuntarat P, Prasertwitayakij N, et al. Prevalence of atrial fibrillation in Thai elderly. J Geriatr Cardiol. 2016; 13(3): 270–273.
    CrossRefPubMed
  16. 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.
    CrossRefPubMed
  17. 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.
    CrossRefPubMed
  18. Su P, McCarthy KP, Ho SY. Occluding the left atrial appendage: anatomical considerations. Heart. 2008; 94(9): 1166–1170.
    CrossRefPubMed
  19. Suradi HS, Hijazi ZM. Left atrial appendage closure: outcomes and challenges. Neth Heart J. 2017; 25(2): 143–151.
    CrossRefPubMed
  20. 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.
    CrossRefPubMed
  21. 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.
    CrossRefPubMed
  22. 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.
    CrossRefPubMed
  23. 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.
    CrossRefPubMed
  24. 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.
    CrossRefPubMed
  25. 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.
    CrossRefPubMed
  26. 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.
    CrossRefPubMed
  27. Yamashita T. Virchow triad and beyond in atrial fibrillation. Heart Rhythm. 2016; 13(12): 2377–2378.
    CrossRefPubMed
  28. Yeow WL, Kar S. Device- and laa-specific characteristics for successful LAA closure: tips and tricks. Interv Cardiol Clin. 2014; 3(2): 239–254.
    CrossRefPubMed
  29. 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.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl