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Karpierz JI, Piotrowski M, Bartuś K, Chmiel R, Wijatkowska K, Słomka A. Device-Assisted Left Atrial Appendage Exclusion: From Basic Sciences to Clinical Applications. J Cardiovasc Dev Dis 2024; 11:332. [PMID: 39452302 PMCID: PMC11508359 DOI: 10.3390/jcdd11100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/05/2024] [Accepted: 10/17/2024] [Indexed: 10/26/2024] Open
Abstract
Device-assisted left atrial appendage exclusion plays a crucial role in the prevention of fatal ischemic complications in patients with atrial fibrillation and contraindications to anticoagulation treatment. Various devices with different safety profiles and device-related complications are available in daily practice to perform this procedure. In this review, the anatomy, physiology, and functions of the left atrial appendage were detailed, and all available devices used for epicardial and endocardial exclusion of the left atrial appendage and their clinical outcomes were discussed. Future research should aim to further investigate the long-term effects of left atrial appendage exclusion on body homeostasis, blood coagulation, and cardiac function.
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Affiliation(s)
- Julia Izabela Karpierz
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Piotrowski
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
| | - Krzysztof Bartuś
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
| | - Radosław Chmiel
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Katarzyna Wijatkowska
- Department of Cardiac Anesthesiology, Regional Specialist Hospital, 86-300 Grudziądz, Poland
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
- National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Street, 02-507 Warsaw, Poland
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Heidari H, Kanschik D, Erkens R, Maier O, Wolff G, Bruno RR, Werner N, Daniel Reinartz S, Antoch G, Kelm M, Zeus T, Jung C, Afzal S. Left atrial appendage sizing for percutaneous closure in virtual reality-a feasibility study. Front Cardiovasc Med 2023; 10:1188571. [PMID: 37727301 PMCID: PMC10506402 DOI: 10.3389/fcvm.2023.1188571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
Background and aims The complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures (LAAC) challenging. Several imaging modalities [e.g. echocardiography, multi-slice computed tomography (MSCT)] are used for this purpose. Virtual reality (VR) is an emerging imaging technique to immerse into a three-dimensional left atrium and appendage, offering unprecedented options of visualization and measurement. This study aimed to investigate the feasibility, accuracy and reproducibility of visualizing the LAA in VR for preprocedural planning of LAAC. Methods and results Twenty-one patients (79 ± 7 years, 62% male) who underwent LAAC at University Hospital Düsseldorf were included in our study. A dedicated software generated three-dimensional VR models from preprocedural MSCT imaging data. Conventional measurements of LAA dimensions (ostium, landing zone and depth) using a commercially available software were compared to measurements in VR: MSCT and VR ostium min. (r = 0.93), max. (r = 0.80) and mean (r = 0.88, all p < 0.001) diameters as well as landing zone (LZ) min. (r = 0.84), max. (r = 0.86) and mean diameters (r = 0.90, all p < 0.001) showed strong correlations. Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05). Conclusion Virtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation. Further studies need to explore additional benefits of three-dimensional visualization for operators in preprocedural planning.
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Affiliation(s)
- Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nikos Werner
- Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Sebastian Daniel Reinartz
- Institute of Diagnostic and Interventional Radiology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Clinic Duesseldorf, Heinrich-Heine University Duesseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
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Maresch AC, Chacon MM, Markin NW. Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography-Fluoroscopy Fusion Imaging. J Cardiothorac Vasc Anesth 2021; 36:8-11. [PMID: 34376345 DOI: 10.1053/j.jvca.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew C Maresch
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - M Megan Chacon
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
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