Abstract
The success and procedural complexities of percutaneous left atrial appendage (LAA) closure depends largely on the LAA anatomy, and on the anatomic relations between access to the left atrium via the fossa ovalis to the LAA. These anatomic features and three-dimensional cardiac structural relationships are distinctly depicted on cardiac computed tomography angiography (CCTA), especially since the LAA has minimal dynamic role during the cardiac cycle. The spatial resolution and three-dimensional structural depiction of CCTA offers unique imaging planes not appreciated with transesophageal echocardiography (TEE), which has been the conventional pre-imaging modality-of-choice for LAA closure. As with other structural cardiac interventions, the noninvasiveness, superiority in imaging resolution and relational portrayal have progressively established CCTA as instrumental preplanning imaging tool, and is anticipated to overtake TEE as the pre-imaging modality-of-choice for LAA closure. For preplanning imaging, CCTA allows not only anatomic LAA assessment, but also ruling out preexisting thrombus in the LAA that would exclude attempt at LAA closure. In addition, post-surveillance of LAA closure is necessary to rule out device-related thrombus and residual leak, and CCTA can contribute to this important role. This chapter will review the practical utility of CCTA in preplanning and guiding LAA closure, and post-procedural surveillance.
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References
Di Biase L, Santangeli P, Anselmino M, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012;60:531–8.
Ucerler H, Ikiz ZA, Ozgur T. Human left atrial appendage anatomy and overview of its clinical significance. Anadolu Kardiyol Derg. 2013;13:566–72.
Stollberger C, Schneider B, Finsterer J. Is percutaneous left atrial appendage transcatheter occlusion an alternative to oral anticoagulation in patients with atrial fibrillation? Circulation. 2003;107:e11–2; author reply e11–2.
Su P, McCarthy KP, Ho SY. Occluding the left atrial appendage: anatomical considerations. Heart. 2008;94:1166–70.
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 for echocardiographic examination. Circulation. 1997;96:3112–5.
Ernst G, Stollberger C, Finsterer J. Determination of left atrial appendage morphology. Circulation. 1998;98:2355.
Ernst G, Stollberger C, Abzieher F, et al. Morphology of the left atrial appendage. Anat Rec. 1995;242:553–61.
Somerville W, Chambers RJ. Systemic embolism in mitral stenosis: relation to the size of the left atrial appendix. Br Med J. 1964;2:1167–9.
Wang Y, Di Biase L, Horton RP, Nguyen T, Morhanty P, Natale A. Left atrial appendage studied by computed tomography to help planning for appendage closure device placement. J Cardiovasc Electrophysiol. 2010;21:973–82.
Troupis J, Crossett M, Scneider-Kolsky M, Nandurkar D. Presence of accessory left atrial appendage/diverticula in a population with atrial fibrillation compared with those in sinus rhythm: a retrospective review. Int J Cardiovasc Imaging. 2012;28:375–80.
Shi AW, Chen ML, Yang B, Cao KJ, Kong XQ. A morphological study of the left atrial appendage in Chinese patients with atrial fibrillation. J Int Med Res. 2012;40:1560–7.
Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. Heart Rhythm. 2013;10:921–5.
Verma S. Left atrial appendage and thromboembolism: shape matters. Heart Rhythm. 2013;10:926–7.
Anselmino M, Scaglione M, Di Biase L, et al. Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation. Heart Rhythm. 2014;11:2–7.
Khurram IM, Dewire J, Mager M, et al. Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation. Heart Rhythm. 2013;10:1843–9.
Lee JM, Shim J, Uhm JS, et al. Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation. Am J Cardiol. 2014;113:963–9.
Shirani J, Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol. 2000;9:95–101.
Nedios S, Tang M, Roser M, et al. Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment. J Interv Card Electrophysiol. 2011;32:87–94.
Ho SY, Cabrera JA, Sanchez-Quintana D. Left atrial anatomy revisited. Circ Arrhythm Electrophysiol. 2012;5:220–8.
Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med. 1995;123:817–22.
Hwang JJ, Chen JJ, Lin SC, et al. Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations. Am J Cardiol. 1993;72:677–81.
Romero J, Husain SA, Kelesidis I, Sanz J, Medina HM, Garcia MJ. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. Circ Cardiovasc Imaging. 2013;6:185–94.
Hong SJ, Kim JY, Kim JB, et al. Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation: a multicenter propensity-matched analysis. Heart Rhythm. 2014;11:763–70.
Dorenkamp M, Sohns C, Vollmann D, et al. Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: role of transesophageal echocardiography and multidetector computed tomography. Int J Cardiol. 2013;163:26–33.
Gottlieb I, Pinheiro A, Brinker JA, et al. Diagnostic accuracy of arterial phase 64-slice multidetector CT angiography for left atrial appendage thrombus in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2008;19:247–51.
Kim YY, Klein AL, Halliburton SS, et al. Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: a comparison with transesophageal echocardiography. Am Heart J. 2007;154:1199–205.
Martinez MW, Kirsch J, Williamson EE, et al. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging. 2009;2:69–76.
Patel A, Au E, Donegan K, et al. Multidetector row computed tomography for identification of left atrial appendage filling defects in patients undergoing pulmonary vein isolation for treatment of atrial fibrillation: comparison with transesophageal echocardiography. Heart Rhythm. 2008;5:253–60.
Tang RB, Dong JZ, Zhang ZQ, et al. Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation. J Interv Card Electrophysiol. 2008;22:199–203.
Wu X, Wang C, Zhang C, Zhang Y, Ding F, Yan J. Computed tomography for detecting left atrial thrombus: a meta-analysis. Arch Med Sci. 2012;8:943–51.
Hur J, Kim YJ, Lee HJ, et al. Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology. 2009;251:683–90.
Hur J, Kim YJ, Lee HJ, et al. Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography. Stroke. 2011;42:2471–7.
Hur J, Kim YJ, Lee HJ, et al. Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 2012;263:688–95.
van Rosendael PJ, Katsanos S, van den Brink OW, et al. Geometry of left atrial appendage assessed with multidetector-row computed tomography: implications for transcatheter closure devices. EuroIntervention. 2013;10(3):364–71.
DeJong PM, Lempereur M, Gin K, Jue J, Saw J. Changes in left atrial appendage dimensions following volume loading during percutaneous closure. Can J Cardiol. 2014;10:S218–9.
Patel AR, Fatemi O, Norton PT, et al. Cardiac cycle-dependent left atrial dynamics: implications for catheter ablation of atrial fibrillation. Heart Rhythm. 2008;5:787–93.
Suh IW, Song JM, Lee EY, et al. Left atrial volume measured by real-time 3-dimensional echocardiography predicts clinical outcomes in patients with severe left ventricular dysfunction and in sinus rhythm. J Am Soc Echocardiogr. 2008;21:439–45.
Lickfett L, Dickfeld T, Kato R, et al. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol. 2005;16:582–8.
Freixa X, Tzikas A, Basmadjian A, Garceau P, Ibrahim R. The chicken-wing morphology: an anatomical challenge for left atrial appendage occlusion. J Interv Cardiol. 2013;26:509–14.
Poulter RS, Tang J, Jue J, et al. Cardiac computed tomography follow-up of left atrial appendage exclusion using the Amplatzer Cardiac Plug device. Can J Cardiol. 2012;28:119; e1–3.
Saw J, DeJong PM, Lempereur M, et al. Cardiac CT angiography follow-up of left atrial appendage closure with the Amplatzer Cardiac Plug. Catheter Cardiovasc Interv. 2014;83:S91.
Saw J, Fahmy P, DeJong PM et al. Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure. Eur Heart J Cardiovasc Imaging. 2015.
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Saw, J., Lopes, J.P., Reisman, M., Bezerra, H.G. (2016). CT Imaging for Percutaneous LAA Closure. In: Saw, J., Kar, S., Price, M. (eds) Left Atrial Appendage Closure. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-16280-5_8
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DOI: https://doi.org/10.1007/978-3-319-16280-5_8
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