By Randall Lee MD PhD

This factor of Interventional Cardiology Clinics examines methods to left atrial appendage exclusion. issues comprise stroke and bleeding dangers in sufferers with atrial traumatic inflammation, embryology and anatomy, cause, catheter-based endocardial closure, pericardial entry, catheter-based epicardial closure, surgical closure, gadget and left atrial appendage particular attribute for profitable closure, medical effects, the position of CTA and MRA imaging, imaging with TEE, post-procedural administration, and prevention and administration of complications. 

 "…An first-class e-book, written by way of specialists within the field...I could hugely suggest it to scientific and surgical employees attracted to this subject." Reviewed by Perfusion, Apr 2015

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CT (A) and MRI (B) scans of windsock LAA morphology. Windsock LAA morphology presents 1 dominant lobe of sufficient length as the primary structure. Variations of this LAA type arise with the location and number of secondary or even tertiary lobes. (From 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. ) 195 196 Kanmanthareddy et al Fig. 8. CT (A) and MRI (B) scans of cauliflower LAA morphology.

What is clear is that with any antithrombotic drug, bleeding will always be an important complication. If we consider warfarin to be problematic, the success of the newer agents is to be possibly less problematic. 1 Oral anticoagulant therapy with warfarin is the standard of care and reduces stroke risk by two-thirds. Unfortunately, oral anticoagulant therapy has several important limitations, most important among them being bleeding. Major bleeding occurs at a relentless rate of about 3% per year among patients taking warfarin, with a cumulative incidence of 10% to 20% in 3 to 4 years of treatment.

4. The anatomy of the LA and LAA. (A) The tubular nature of the left appendage. (B) The interior of the atrium is shown having reflected the pulmonary venous component, which forms the atrial roof. RPV, right pulmonary vein. (From Mommersteeg MT, Christoffels VM, Anderson RH, et al. Atrial fibrillation: a developmental point of view. 7 Pectinate muscles increase in their size with age and more than 97% Table 1 Classification of LAA based on morphology Morphologic Type Description Cactus Chicken wing Windsock Cauliflower Predominant central lobe with secondary lobes extending in superior and inferior directions The LAA folds back on itself at some distance from the perceived left atrial ostium Has 1 dominant lobe of sufficient structure and may have secondary or tertiary lobes arising from the primary lobe Has limited length with irregular internal characteristics From Wang Y, Di Biase L, Horton RP, et al.

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