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Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target.

Regazzoli D, Ancona F, Trevisi N, Guarracini F, Radinovic A, Oppizzi M, Agricola E, Marzi A, Sora NC, Della Bella P, Mazzone P - Biomed Res Int (2015)

Bottom Line: However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings.The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis.This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

View Article: PubMed Central - PubMed

Affiliation: Non-Invasive Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.

ABSTRACT
Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC). However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA), where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

No MeSH data available.


Related in: MedlinePlus

The image shows the so-called “tug test.” An Amplatzer Cardiac Plug is pulled before the deployment. During this maneuver, the distal part of the device (“disk,” arrow) is put in tension, while the distal part (“lobe”) remains anchored in left atrial appendage.
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fig9: The image shows the so-called “tug test.” An Amplatzer Cardiac Plug is pulled before the deployment. During this maneuver, the distal part of the device (“disk,” arrow) is put in tension, while the distal part (“lobe”) remains anchored in left atrial appendage.

Mentions: After deployment, a tug test should be performed demonstrating simultaneous movement of the device and appendage (Figure 9). Optimally, the device should not protrude >4–7 mm beyond the LAA ostium, and residual flow should be <5 mm by color Doppler with a compression grade of  8–20%, expressed in percent comparing the diameter of the implanted device with the unconstricted diameter indicated by the manufacturer. When optimal positioning is confirmed, the device is released. Rare device embolization after mobilization of the patient has been observed.


Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target.

Regazzoli D, Ancona F, Trevisi N, Guarracini F, Radinovic A, Oppizzi M, Agricola E, Marzi A, Sora NC, Della Bella P, Mazzone P - Biomed Res Int (2015)

The image shows the so-called “tug test.” An Amplatzer Cardiac Plug is pulled before the deployment. During this maneuver, the distal part of the device (“disk,” arrow) is put in tension, while the distal part (“lobe”) remains anchored in left atrial appendage.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4508372&req=5

fig9: The image shows the so-called “tug test.” An Amplatzer Cardiac Plug is pulled before the deployment. During this maneuver, the distal part of the device (“disk,” arrow) is put in tension, while the distal part (“lobe”) remains anchored in left atrial appendage.
Mentions: After deployment, a tug test should be performed demonstrating simultaneous movement of the device and appendage (Figure 9). Optimally, the device should not protrude >4–7 mm beyond the LAA ostium, and residual flow should be <5 mm by color Doppler with a compression grade of  8–20%, expressed in percent comparing the diameter of the implanted device with the unconstricted diameter indicated by the manufacturer. When optimal positioning is confirmed, the device is released. Rare device embolization after mobilization of the patient has been observed.

Bottom Line: However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings.The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis.This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

View Article: PubMed Central - PubMed

Affiliation: Non-Invasive Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.

ABSTRACT
Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC). However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA), where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

No MeSH data available.


Related in: MedlinePlus