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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.
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).