The left atrial appendage revised

Abstract Nonvalvular atrial fibrillation is associated with a 4- to 5-fold strokes increase and may be responsible for 15% to 20% of all strokes in the elderly. In this scenario, the left atrial appendage thrombus would be the associated with 90% of cases. The use of anticoagulants, percutaneous devices, and the left atrial appendage surgical exclusion is still an open discussion. For left atrial appendage procedures, relevant anatomic spatial relationships have to be emphasized, besides the chance of the normal physiological functioning would be eliminated with the proceedings. There are evidences that the left atrial appendage closure during routine cardiac surgery is significantly associated with an increased risk of early postoperative atrial fibrillation. Therefore, the purpose of this review is to focus basic aspects for continuous medical education. In summary, the rationale of this text is to emphasize anatomical and pharmacological aspects involved in the simple surgical exclusion of left atrial appendage under cardiopulmonary bypass. There are several operative techniques, but to conclude this revision it will present one of them based on the discussed basic sciences.

Value of transesophageal echocardiography in assessment of left atrial appendage function

In AF, cardiogenic emboli are the sources of transient ischemic attack [TIA] and stroke in 20-40% of patients, and the left atrial appendage [LAA] is almost always the site of thrombus formation [Hart and Halperin, et al., 2001]. To evaluate the value of transesophageal echocardiography [TEE] in assessment of left atrial appendage function The study will include sixty consecutive patients with indication for TEE assessment to detection of left atrial appendage [LAA] thrombi at BAB AL-SHE>RYIA University Hospital - Al-Azhar University, between December, 2009 to April, 2010 ,30 patientswith history of ischemic stroke, 30 patients with dilated left atrium ,A11 subjects will be subjected to the followings:-Full history- Clinical examination -12 leads resting ECG- TranSoesophageal echocardiography used to to visualize the LA, LAA and RAA. LAA area [LAA a] and volume [LAA v] was obtained by area length method [Pollick and Taylor, 1991]. will show highly statistically significant values between patients groups in the following LAA emptying velocity [LAA vel] ,LA appendage AM wave [LAA AM] and with no significant values in LAA area [LAA a], LAA volume [LAA v] LA appendage EM wave [LAA EM], LA appendage SM wave[LAASM] The LAA end diastolic tissue Doppler velocity [LAA AM] is a parameter that allows evaluate the LAA myocardial function with stress on TTE as non invasive test

Relationship of left atrial appendage function to left ventricular function.

BACKGROUND: The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm. METHODS AND RESULTS: The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001). CONCLUSIONS: Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.