Coll. Bakalli A, Kamberi L, Pllana E, Zahiti B, Dragusha G, Brovina A. Unless contraindicated, cardiac CTA was performed after vasodilation with oral nitroglycerin and administration of IV metoprolol in patients with heart rates of 60 beats per minute or more. However, to our knowledge, the prevalence and morphologic appearance of accessory left atrial appendages and diverticula in vivo have not been described to date. AsirvathamA review of the relevant embryology, pathohistology, and anatomy of the left atrial appendage for the invasive cardiac electrophysiologist. Hara H, Virmani R, Holmes DR et-al. Assessment of the left atrial appendage (LAA) for thrombus and anatomy is important prior to atrial fibrillation (AF) ablation and LAA exclusion. ... Anomalous pulmonary venous anatomy. (2010) Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir. This matches the common locations of left atrial accessory append ages as observed in our study. Four main morphological types have been described: 1. chicken wing: 48% 2. cactus: 30% 3. windsock: 19% 4. cauliflower: 3%. In the latter case, an intermittent friction rub simulating pericarditis was apparently caused by the motion of the diverticulum as it rubbed to and fro against the pericardial surface [10]. (2002) Journal of the American College of Cardiology. JACC Cardiovasc Imaging. Descriptive statistics were calculated. Diverticula have also been associated with occurrence of supraventricular arrhythmia, which is believed to be produced by a large area of abnormal atrial wall [10, 11]. 26 (9): 921-64. Left atrial appendage (LAA) closure requires accurate preprocedural measurements, and trans‐esophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy can be utilized. [5] found in a series of 50 patients that 21 patients (42%) had endocardial “irregularities” along the roof of the left atrium, with the most common finding being a smooth diverticulum (14 patients, 28%). The left atrial appendage (LAA) is a finger-like extension originating from the main body of the left atrium. Antonielli E, Pizzuti A, Pálinkás A, Tanga M, Gruber N, Michelassi C, Varga A, Bonzano A, Gandolfo N, Halmai L, Bassignana A, Imran MB, Delnevo F, Csanády M, Picano E. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. The left atrial appendage is a small structure that resembles a finger coming off the left atrium of the human heart. Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion. Other described abnormalities of the atrial appendages are juxtaposition of the atrial appendages, which is a rare cardiac anomaly in which both atrial appendages lie to one side of the great arteries [1]. 1, 2 Smaller than its counterpart on the right, 3 the LAA varies in size and shape, and in its relationship with surrounding structures. 1A, 1B). 2, NO. Left Atrial Appendage: Embryology, Anatomy, Physiology, Arrhythmia and Therapeutic Intervention. Lee et al. The left atrial appendage (LAA) is a finger-like extension originating from the main body of the left atrium. Recent studies have demonstrated that pre-procedural CT reconstruction is useful to classify a wide range of variations in morphology of the left atrial appendage. Table 1 summarizes the characteristics of the group with atrial diverticula or accessory appendages. Ravi Rasalingam, Majesh Makan, Julio E. Perez. The left atrial appendage is derived from the primitive atrium and has a rough, trabeculated surface. Accessory left atrial appendages tend to be smaller than diverticula and are more commonly found on the left lateral atrial wall. In terms of the atrial diverticula, in both genders the widths were similar (men, 6.2 ± 2.4 mm; women, 5.8 ± 2.7 mm; p = 0.41), but men tended to have longer atrial diverticula than women (men, 6.7 ± 2.6 mm; women, 4.9 ± 1.8 mm; p = 0.002). Anatomy. 923–929, 2012. Congenital giant left atrial appendage aneurysm: a case report. 2014;7 (12): 1251-65. Most of the accessory appendages had a left lateral inferior location, whereas most of the diverticula had a superior anterior location (Figs. The left atrial appendage: anatomy, function, and noninvasive evaluation. The right atrial appendage (RAA) is shown in yellow and the venous component of the right atrium in blue. TEE provides high-resolution multiplanar imaging that is especially suitable for evaluating soft tissue. (2016) JACC. Wan et al. Thus, the goal of this study is to determine the prevalence, imaging characteristics, and anatomic locations of accessory appendages and diverticula of the left atrium in patients who underwent cardiac CT for coronary artery evaluation. 11.1 Conventional left atrial anatomy (LAA). J Atr Fibrillation, 8 (2015), pp. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Methods Al-Saady NM, Obel OA, Camm AJ. CONCLUSION. • Although LAA volumes increase, LAAEF decreases with age in both sexes. The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics. 53 The lateral course passes over the tip of the left atrial appendage, whereas the posteroinferior course passes over the roof of the appendage os. 8. 6A, 6B, 6C and 7A, 7B). On evaluation of the left atrium, an accessory appendage was identified if the structure had a discernible ostium at the left atrium with a neck and body that displayed irregular contours suggestive of the presence of pectinate muscles (Fig. We also aimed to evaluate the potential clinical relevance of the presence of these structures. Two investigators with 1 and 10 years of experience in cardiovascular CTA reviewed the images retrospectively via a consensus reading. One case was reported in association with severe mitral regurgitation, suggesting that finding may play a role in the formation of left atrial diverticula [9]. • Cardiac CT is reliable for left atrial appendage volume measurements. An atrial diverticulum was identified if the structure had a saclike shape with a broad-based ostium and a smooth contour to its body (Fig. Of these patients, 408 (77%; 256 men, 63%; 152 women, 37%) had neither a left atrial diverticulum nor an accessory appendage, whereas 121 patients (23%; 96 men, 79%; 25 women 21%) were found to have accessory appendages or diverticula. Background: The left atrial appendage (LAA) is considered the most frequent site of intracardiac thrombus formation. ECG-based tube current modulation was used when appropriate. Table 2 summarizes the locations within the left atrium of both the accessory appendages and diverticula. 10. Imaging parameters included a slice collimation of 64 × 0.6 mm, gantry rotation time of 330 milliseconds with a tube voltage of 100–120 kV and effective tube current of 750–850 mAs. 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