medigraphic.com
ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2019, Number 3

<< Back Next >>

Cir Card Mex 2019; 4 (3)

Relationship between left atrial appendage morphology and thrombus formation in patients with atrial fibrillation and rheumatic mitral valve disease

García-Villarreal OA

Language: English
References: 25
Page: 79-83
PDF size: 178.91 Kb.


ABSTRACT

Background. Left atrial appendage (LAA) is the main source for thrombus formation inside the heart in patients with atrial fibrillation (AF). In cases with valvular- AF other than paroxysmal AF it becomes up to 17- fold higher than expected. Objective. To figure out the relationship between LAA thrombus and morphology in patients with mitral valve disease and concomitant AF. Material and methods. We studied 100 cases operated on for mitral valve surgery and LAA resection, between 1998 and 2007. Eighty-three cases had rheumatic etiology. All cases were as long-standing persistent AF. Results. 19% had some thrombus inside LAA. Nine (9%) showed preoperative stroke (RR= 19.18, CI 95% from 4.50 to 81.65, p= 0.0001). Morphology was cactus (38%), chicken wing (28%), windsock (18%), and cauliflower (16%). Relative risk for LAA thrombus for cauliflower was 9.37 (CI 95% from 3.69 to 23.80, p ‹ 0.0001), cactus (RR= 0.79, CI 95% from 0.391 to 1.633, p = 0.614), Chicken wing (RR = 0.15, CI 95% from 0.022 to 1.090, p= 0.061), and Windsock (RR = 0.25, CI 95% from 0.035 to 1.769, p= 0.165). Conclusions. The most common LAA type in rheumatic mitral valvular patients with AF was cactus. Relative risk for thrombus formation in LAA was only important to cauliflower, with 9.37-fold higher than expected. More broadly, this could have huge implications for future percutaneous as well as surgical strategies.


REFERENCES

  1. Blackshear JL, Oddel JA. Appendage obliteration to reduce stroke in cardiac surgicalpatients with atrial fibrillation. Ann Thorac Surg 1996; 61: 755-9.

  2. Kamel H, Okin PM, Elkind MSV, Iadecola C. Atrial Fibrillation and Mechanismsof Stroke. Time for a New Model. Stroke 2016; 47: 895-900.

  3. Madden JL. Resection of the left auricular appendix, JAMA 1948;140:769-72.

  4. Bailey CP, Olsen AK, Keown KK, Nichols HT, Jamison WE. Commissurotomyfor mitral stenosis: technique for prevention of cerebral complications. JAMA1952; 149: 1085-91.

  5. Belcher JR, Somerville W. Systemic embolism and left auricular thrombosis inrelation to mitral valvotomy. Br Med J 1955; 2:1000-3.

  6. Jordan RA, Scheifley CH, Edwards JE. Mural thrombosis and arterial embolism inmitral stenosis. Circulation 1951;3: 363-7

  7. Johnson WD, Ganjoob AK, Stonec CD, Srivyasa RC, Howard M. The left atrialappendage: our most lethal human attachment! Surgical implications. Eur J CardiothoracSurg 2000; 17: 718-22.

  8. Badhwar V, Rankin S, Damiano Jr RJ, Gillinov MA, Bakaeen FG, Edgerton JR,et al. The Society of Thoracic Surgeons 2017 Clinical practice guidelines for thesurgical treatment of atrial fibrillation. Ann Thorac Surg. 2017;103:329-41.

  9. Veinot JP, Harrity PJ, Gentile F, et al. Anatomy of the normal left atrial appendage.A quantitative study of age-related changes in 500 autopsy hearts: implications forechocardiographic examination. Circulation 1997; 96: 3112-15.

  10. García-Villarreal OA. Hands-free approach for the left atrial appendage in Coxmaze IV. Asian Cardiovasc Thorac Ann 2014;22:1141-3.

  11. Garcia-Villarreal OA. Surgical closure of the left atrial appendage. Basal considerationsbefore attempting with occluder devices. J Surg Open Access 2017;3(2):doi http://dx.doi. org/10.16966/2470-0991.144.

  12. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factorfor stroke: the Framingham Study. Stroke 1991; 22:983-8.

  13. Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment ofchronic atrial fibrillation and risk of stroke: the Framingham study. Neurology1978; 28:973-7.

  14. García-Villarreal OA, Heredia-Delgado JA. Left atrial appendage in rheumaticmitral valve disease: The main source of embolism in atrial fibrillation. Arch CardiolMex 2017; 87(4). http://dx.doi.org/10.1016/j.acmx.2016.11.00.

  15. Cox JL. Mechanical closure of the left atrial appendage: Is it time to be moreaggressive? J Thorac Cardiovasc Surg 2013; 1-10.

  16. Di Biase L, Santageli P, Anselmino M, Mohanty P, Salvetti I, Gili S, et al. Doesthe left atrial appendage morphology correlate with the risk of stroke in patientswith atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol.2012;6:531-8.

  17. Cox JL. The first maze procedure. J Thorac Cardiovasc Surg 2011; 141:1093-7.

  18. Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J ThoracCardiovasc Surg 1991;101:584-92.

  19. Cox JL, Boineau JP, Schuessler RB, Kater KM, Ferguson TB Jr, Cain ME, et al.Electrophysiologic basis, surgical development, and clinical results of the mazeprocedure for atrial flutter and atrial fibrillation. Adv Card Surg. 1995;6:1-67.

  20. Cox JL, Schuessler RB, Boineau JP. The development of the maze procedure forthe treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg. 2000;12: 2-14.

  21. Ad N, Cox JL. Stroke prevention as an indication for the Maze procedure in thetreatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12:56-62.

  22. Ad N, Damiano RJ Jr, Badhwar V, et al. Expert consensus guidelines: Examiningsurgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg 2017;153:1330-54.

  23. Cox JL, Ad N, Palazzo T. Impact of the maze procedure on the stroke rate in patientswith atrial fibrillation. J Thorac Cardiovasc Surg 1999;118:833-40.

  24. Kanderian AS, Gillinov AM, Petterson GB, Blackstone E, Klein AL. Success ofsurgical left atrial appendage closure. Assessment by transesophageal echocardiography.J Am Coll Cardiol 2008; 52: 924-9.

  25. Aryana A, Singh SK, Singh SM, O’Neill PG, Bowers MR, et al. Association betweenincomplete surgical ligation of left atrial appendage and stroke and systemicembolization. Heart Rhythm 2015; 12: 1431-7.




2020     |     www.medigraphic.com