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The left atrial appendage is a pouch-like structure located in the upper part of the left atrium. [1] Left atrial appendage occlusion (LAAO) is an alternative therapy to oral anticoagulation in a certain subset of patients with atrial fibrillation.
The Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) in 2016, establishing uniform coverage for percutaneous left atrial appendage closure (LAAC ...
The left atrial appendage can serve as an approach for mitral valve surgery. [16] The body of the left atrial appendage is anterior to the left atrium and parallel to the left pulmonary veins. The left pulmonary artery passes posterosuperiorly and is separated from the atrial appendage by the transverse sinus. [17]
A common example that demonstrates this is the visibility of the left atrial appendage. This structure is known to form clots in atrial fibrillation and the LAA is rarely seen on TTE but readily seen on TEE. Cardioversion of atrial fibrillation in someone not on anticoagulation would require TEE to best visualize the LAA to rule out a thrombus.
Energy is delivered and the atrial tissue heated and destroyed in a series of steps as the microwave antenna is withdrawn behind the heart. The lesions form a "box-like" pattern around all four pulmonary veins behind the heart. The left atrial appendage is usually removed. [7] [8]
Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. Although other factors may contribute, left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality.
Rotation of the catheter to a "home view" of the left atrium through the mitral valve into the left ventricle. From there, a 180° rotation will face the posterior wall and posterior deflection will bring the left atrial appendage into view and can be used for deployment of a left atrial appendage occlusion device.
This procedure allows for better imaging of the aorta, pulmonary artery, heart valves, atria, atrial septum, left atrial appendage, and coronary arteries. It can also be used during cardiac surgery to monitor the patient and assess the success of surgical interventions. [5]
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