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Anatomical Classification of Left Atrial Appendages in Specimens Applicable to CT Imaging Techniques for Implantation of Amplatzer Cardiac Plug
Author(s) -
LÓPEZMÍNGUEZ JOSÉ R.,
GONZÁLEZFERNÁNDEZ REYES,
FERNÁNDEZVEGAS CONCEPCIÓN,
MILLÁNNUÑEZ VICTORIA,
FUENTESCAÑAMERO MARÍA E.,
NOGALESASENSIO JUAN M.,
DONCELVECINO JAVIER,
ELDUAYENGRAGERA JAVIER,
HO SIEW Y.,
SÁNCHEZQUINTANA DAMIÁN
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12429
Subject(s) - ostium , medicine , atrial fibrillation , appendage , atrial appendage , pulmonary vein , occlusion , cardiology , anatomy , left pulmonary vein , left atrium , nuclear medicine , radiology , sinus rhythm
3‐D Imaging Classification of LAA Background Certain anatomical characteristics of the left atrial appendage (LAA) are associated with complexity in the implantation of occluder devices. Objective The aim was to define characteristics measurable by three‐dimensional imaging that would predict complexities both in the implantation procedure and the selection of the appropriate device size. Methods An anatomical study was performed of 50 postmortem hearts, of which 15 had a history of atrial fibrillation, and of 30 consecutive patients undergoing LAA occlusion with the Amplatzer cardiac plug (ACP). The specimens were classified according to variables that can be visualized using computerized tomography (CT). The CT scans of 30 consecutive patients were classified according to the level of the LAA ostium, the left lateral ridge (LLR), the LAA limbus and distance from LAA to the mitral annulus before undergoing LAA occlusion, and the results were correlated. Results Three types of LAA orifice were defined: type I, with a usually higher, anterior LAA ostium, a short, flattened and wide LLR and almost nonexistent limbus; type II, presenting a long, pointed and narrow LLR, and a longer, more defined limbus; type III, with a lower LAA ostium, close to the left atrium floor and the mitral annulus, a marked separation from the left pulmonary vein orifices and a limbus of intermediate length. Conclusion LAA with lower ostia are more difficult to occlude. Types II and III have very prominent LLRs with longer limbi, which may increase the difficulty of inserting the guide and making measurements for selection of the right ACP size.