Minimally invasive,simplified double-layer left atrial appendage closure

The left atrial appendage (LAA) has been identified as a site of thrombus formation in the heart and as a source of embolism in patients with atrial fibrillation, leading to stroke. Studies suggest that LAA closure may reduce the risk for stroke and the need for anticoagulation; conversely, incomplete closure can increase the stroke risk almost 12-fold. Because open heart surgery is associated with increased risk for subsequent stroke, surgeons generally prefer to close the LAA during heart surgery, as recommended in current atrial fibrillation management guidelines. Building on trends toward minimally invasive approaches in cardiac surgery, we developed a simple, unique, and reproducible method for complete LAA closure during mitral valve surgery that has proven to be safe and efficacious: Our first three patients remained completely free from stroke and minor neurological manifestations 27 months after surgery.     

Aneurysm of the left atrial appendage

We present the case of a 33-year-old woman with atrial tachyarrhythmias and chest pain. The transthoracic echocardiography demonstrated an intrapericardial liquid mass confirmed as an aneurysm of the left atrial appendage by a nuclear magnetic imaging study. Aneurysmectomy was performed with the assistance of cardiopulmonary bypass with a bilateral submammary skin incision and subsequent median sternotomy. The patient had an uneventful postoperative course. We suggest aneurysmectomy aided by cardiopulmonary bypass as a safer method of treatment for this rare cardiac anomaly.     

Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage

OBJECTIVES The exclusion of the left atrial appendage (LAA) has been used to reduce the risk of stroke associated with atrial fibrillation (AF). While LAA exclusion has been associated with a reduced risk of stroke, the effect on the electrical activity of the LAA (a potential source of AF) remains unknown. As such, we sought to demonstrate whether surgical epicardial clip occlusion leads to the electrical isolation of the LAA. METHODS From December 2010 until August 2011, 10 patients with paroxysmal AF underwent off-pump coronary artery bypass surgery with bilateral pulmonary vein isolation and an LAA clip occlusion with a new epicardial clip. Before and after the clip was placed, pacing manoeuvres were performed to assess the electrical exit and entry blocks from the LAA. RESULTS All clips were applied successfully. The mean procedure time for the clip application was 4?±?1?min. No complications occurred related to clip application. Prior to the pericardial closure, 18?±?3?min after the clip placement, the LAA stimulation and pacing manoeuvres demonstrated complete electrical isolation of the LAA in all cases. CONCLUSIONS Epicardial LAA clip occlusion leads to the acute electrical isolation of the LAA and may not only provide stroke prevention but also reduce the recurrence of AF.     

Inverted left atrial appendage.

An unexpected left atrial mass was found during postoperative echocardiography in a 17-years old man following aortic valve replacement, suggesting thrombus, vegetation and neoplasm. Reoperation showed that the mass to be an inverted left atrial appendage. Left ventricular venting may cause such inversion. To prevent this complication, we suggest the use of careful monitoring and intraoperative transesophageal echocardiography.     

Idiopathic left atrial appendage rupture

Cardiac rupture is mainly caused by myocardial infarction or blunt chest trauma. We present a case of idiopathic left atrial appendage rupture.     

Congenital aneurysm of the left atrial appendage

Aneurysm of the left atrial appendage (LAA) is very infrequent. We present the case of 24-year-old man in functional class I with atrial fibrillation but no other symptoms. Radiology showed an abnormality in the outline of the heart. Echocardiography revealed left appendage aneurysm. After median sternotomy, aneurysmectomy was performed under cardiopulmonary bypass without cross clamping. Atrial fibrillation ceased as soon as the aneurysm had been removed. There were no postoperative complications. Three months later the patient remained asymptomatic and in sinus rhythm.     

Congenital intrapericardial left atrial appendage aneurysm

Congenital true aneurysms of left atrial appendage are very rare. Abnormal cardiac silhouette on the chest roentgenograph is usually an important clue for the diagnosis. They are commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We report here the surgically-corrected case of a patient with congenital left atrial appendage aneurysm.     

Intrapericardial aneurysm of the left atrial appendage.

A 24-year-old housewife with congenital aneurysm of the left atrial appendage underwent a successful operation for its removal. Operation, using cardiopulmonary bypass, is indicated in all patients with atrial aneurysm. The procedure has proved uniformly safe and successful.     

Congenital intrapericardial aneurysm of the left atrial appendage

Congenital aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. It represents a diagnostic dilemma in patients with cardiomegaly and is commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe the diagnostic evaluation and surgical treatment during 1997 of a patient with congenital aneurysmal dilatation of the left atrial appendage. The patient was discharged previously from our hospital in 1967 with the diagnosis of congenital dilatation of the pulmonary artery.     

Inverted left atrial appendage presenting as a large left atrial mass

Inverted left atrial appendage (ILAA) is a rare phenomenon. We describe a patient with mitral stenosis who presented with a homogenous mass in the left atrium, mimicking a large thrombus. The patient was sent to surgery and no thrombus was found; intraoperative examination by the surgeon revealed an ILAA. We briefly discuss the main features of this entity and also some aspects of the differential diagnosis.     

Idiopathic giant aneurysm of left atrial appendage

Indian Journal of Thoracic and Cardiovascular Surgery -     

Partial left pericardial defect with herniation of the left atrial appendage

A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the presence of a pleuropericardial defect. The surgical procedure included excision of the appendage and closure of the defect.