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Recanalization of the left atrial appendage demonstrated by transesophageal echocardiography
M Lynch1, J S Shanewise, G L Chang
1Department of Medicine, Emory University Hospital, Atlanta, Georgia 30322, USA.
Insights
Surgical closure of the left atrial appendage during mitral valve surgery can reopen. Recanalization of the appendage orifice was observed in 6 patients, potentially impacting stroke prevention strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anatomy
- Interventional Cardiology
Background:
- Left atrial appendage closure is recommended during mitral valve operations to prevent postoperative thrombus formation and systemic embolization.
- Surgical techniques aim for durable occlusion of the appendage orifice.
Observation:
- This study reports on 6 patients who underwent mitral valve replacement with surgical closure of the left atrial appendage using pursestring suturing.
- Postoperative assessment revealed unexpected findings regarding the integrity of the closure.
Findings:
- Transesophageal echocardiography demonstrated disruption of the pursestring closure line in these patients.
- Partial recanalization of the sutured left atrial appendage orifice was observed.
- High-velocity flow was noted between the left atrial body and the recanalized appendage.
Implications:
- These findings suggest that surgical closure of the left atrial appendage may not always be permanent.
- Recanalization could compromise the intended prophylactic effect against thromboembolism.
- Further research is needed to optimize surgical techniques and evaluate long-term outcomes of appendage closure.
Abstract:
Closure of the fibrillating left atrial appendage has been recommended during mitral valve operations to help prevent thrombus formation and systemic embolization postoperatively. We report recanalization of the appendage orifice in 6 patients after surgical closure by pursestring suturing at the time of mitral valve replacement. Transesophageal echocardiography demonstrated disruption of the closure line and partial recanalization of the sutured orifice with relatively high velocity flow between the left atrial body and the appendage.