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Interventional cardiology
Left atrial appendage: anatomy and imaging landmarks pertinent to percutaneous transcatheter occlusion
  1. José Angel Cabrera1,
  2. Farhood Saremi2,
  3. Damián Sánchez-Quintana3
  1. 1Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain
  2. 2Department of Radiology, University of Southern California, Los Angeles, California, USA
  3. 3Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
  1. Correspondence to Dr JA Cabrera, Hospital Universitario Quirón-Madrid, European University of Madrid, Calle de Diego de Velázquez. Pozuelo de Alarcón, Madrid 28223, Spain; jac11339{at}yahoo.uk

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Percutaneous left atrial appendage (LAA) closure represents a complementary option and effective treatment for patients at risk of thromboembolism, especially in patients for whom it may be difficult to achieve satisfactory anticoagulation control or where anticoagulation treatment is not possible or desirable.

Effective and safe transcatheter LAA occlusion requires a detailed knowledge of crucial anatomic landmarks and endocardial morphologic variants of the LAA and its neighbouring structures.1 ,2 w1–w3 Our aim in this article is to provide the basic anatomic information that is important for the interventional cardiologist to know when planning an LAA occlusion procedure.

Atrial components

The right atrium (RA) forms the rightward and anterior part of the cardiac mass. This overlaps the right band margin of the left atrium (LA). The leftward margin of the RA is marked posteriorly by the interatrial groove, which lies between the superior caval vein and the right pulmonary veins. Owing to the obliquity of the interatrial septum (IAS) plane (approximately 65° from the sagittal plane), and to the different levels of the mitral and tricuspid valve orifices, the left atrium is turned and situated posterior and superior to the right atrium. Only the tip of the LAA contributes to the left cardiac silhouette in a frontal fluoroscopic view of the body (figure 1).

Figure 1

Spatial relationship of the atrial structures as they lie in the body. Posterior, right lateral, and superior view of volume rendered CT angiographies are shown. The left atrium (LA in red) is located superior and posterior to the right atrium. Its superior (S) and posterior (P) walls are shown by double-headed arrows. The right atrial appendage (RAA) is shown in yellow and the venous component of the right atrium in blue. The coronary sinus (CS) tributaries are shown in green. IVC, inferior vena cava; LAA, left atrial …

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