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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The surgical anatomy of hearts with isomeric atrial appendages-implications for surgical management
Diane E Spicer1,2, Ujjwal Kumar Chowdhury3, Robert H Anderson4
1Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Insights
Cardiac malformations in heterotaxy syndromes can be classified by atrial appendage isomerism. This anatomical classification aids in surgical planning for these complex congenital heart conditions.
Area of Science:
- Cardiology
- Developmental Biology
- Medical Imaging
Background:
- Heterotaxy syndromes present complex cardiac malformations with jumbled thoracic and abdominal organs.
- Current classification lacks consensus, hindering distinct surgical approaches.
- Patients are often grouped under the umbrella term 'heterotaxy'.
Purpose of the Study:
- To assess if cardiac lesions in heterotaxy can be segregated based on atrial appendage isomerism.
- To establish a clear classification for surgical management of heterotaxy syndromes.
Main Methods:
- Review of autopsy specimens and computed tomographic (CT) studies.
- Analysis of surgical patient cohort data.
- Assessment of atrial appendage anatomy, specifically pectinate muscle extent and bronchial arrangement.
Main Results:
- Individuals with heterotaxy can be uniformly segregated into subgroups based on isomeric atrial appendages.
- Classification by atrial appendage isomerism correlated excellently with bronchial arrangement.
- The extent of pectinate muscles relative to atrial vestibules proved a reliable criterion.
Conclusions:
- Segregation of heterotaxy patients into right or left atrial appendage isomerism subgroups is feasible.
- This classification provides a framework for assessing appropriate surgical management.
- Anatomical segregation aids cardiac surgeons in planning interventions.
Objectives:
The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages.
Methods And Results:
A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention.
Conclusions:
When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management.
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