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Updated: Feb 6, 2026
Left Coronary Artery Ligation: A Surgical Murine Model of Myocardial Infarction
Published on: August 9, 2022
ST-segment elevation myocardial infarction possibly caused by thromboembolism from left atrial appendage thrombus
Ahmet Guner1, Alev Kılıcgedik1, Macit Kalçık2
1Department of Cardiology, Kosuyolu Kartal Training and Research Hospital, Istanbul, Turkey.
Insights
Coronary embolism, a cause of acute coronary syndromes, is often missed. Incomplete left atrial appendage ligation in atrial fibrillation patients significantly increases stroke risk compared to complete ligation.
Area of Science:
- Cardiology
- Vascular Medicine
- Cardiac Surgery
Background:
- Coronary embolism (CE) accounts for 3% of acute coronary syndromes and is often overlooked in diagnosis.
- CE can originate from various cardiac sources or occur paradoxically through intracardiac shunts.
- Left atrial appendage (LAA) ligation is a strategy to prevent embolic events in patients with atrial fibrillation (AF).
Observation:
- A recent study investigated the outcomes of LAA ligation in patients with AF undergoing mitral valve surgery.
- The study specifically examined the association between the completeness of LAA ligation and the risk of subsequent embolic events.
Findings:
- Incomplete LAA ligation was associated with a substantially higher risk of stroke or systemic embolization (24%) compared to complete ligation (2%).
- This highlights a significant difference in embolic event rates based on the technical success of LAA ligation.
Implications:
- Incomplete LAA ligation poses a considerable risk for patients with AF, underscoring the importance of surgical technique.
- Ensuring complete LAA ligation may be crucial for reducing the incidence of stroke and other embolic complications in this patient population.
- These findings emphasize the need for vigilance in diagnosing CE and optimizing surgical procedures for embolic risk reduction.
Abstract:
Coronary embolism (CE) is the underlying cause of 3% of acute coronary syndromes but is frequently overlooked in the differential diagnoses of acute coronary syndromes. The CE may be direct (left sided from the native or prosthetic heart valve, the left atrium, left atrial appendage or pulmonary venous bed), paradoxical (from the venous circulation through a patent foramen ovale, atrial septal defect, ventricular septal defects, cyanotic congenital heart defects or pulmonary arteriovenous malformations), or iatrogenic (following cardiac interventions. In patients with atrial fibrillation (AF), left atrial appendage (LAA) ligation during mitral valve surgery has long been recommended to decrease the future risk of embolic events such as myocardial infarction or ischemic stroke. Recently, Aryana et al reported that in patients with AF who underwent surgical ligation of LAA, the presence of incomplete ligation was associated with a significantly higher risk of stroke/systemic embolization than complete ligation (24% vs 2%).
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