BACKGROUND: The efficacy of oral anticoagulant therapy in reducing the risk of stroke and systemic embolism has been demonstrated in patients with nonrheumatic atrial fibrillation, but anticoagulation may introduce the risk for serious complications or adversely affect the patient's usual activities. Because the left atrial appendage(LAA) is the most likely site of thrombus formation in patients with nonrheumatic atrial fibrillation, evaluation of the LAA function with transesophageal echocardiography(TEE) may be helpful to deterrnine the high risk group for ischemic stroke. METHODS: Twenty patients with nonrheumatic atrial fibrillation(group I ), eighteen patients with rheumatic atrial fibillation(group II ) and twenty subjects in normal sinus rhythm without valvular heart disease(group III ) were underwent multiplane TEE examination. We measured maximal and minimal areas, ejection-fraction, and peak contraction and relaxation velocities of LAA. We also observed the presence or absence of thrombus and spontaneous echo contrast (SEC) in the left atrium or LAA. RESULTS: Maximal area of LAA was larger in group I and II compared with group III but there was no difference between group I and group II. Ejection fraction of LAA was much decreased in group I and II compared with group III. Peak contraction and relaxation velocities of LAA were over 45cm/sec in all cases from group Ill, but there was nearly negligible flow measurable in cases from group II. Patients from group I showed two distinct LAA flow patterns, either well defined saw tooth flow pattem(9 cases) or very low flow pattern like that of group II (11 cases). Therefore, patients from group I could be divided into two subgroups according to LAA flow profile. High flow profile subgroup had clear saw tooth flow pattern and revealed over 20cm/sec of peak contraction and relaxation velocities. The other low flow profile subgroup showed under 20cm/sec of both velocities. LAA ejection fraction was more increased in high flow profile subgroup but not significantly. Ischemic stroke occurred in six patients from group I, and all were in the low flow profile subgroup(p<0.05). SEC was observed in eight cases(73%) of the low flow profile subgroup but in only one case(11%) of the high profile sbugroup(p<0.05). All three cases with LAA thrombus belonged to the low flow profile subgroup. CONCLUSIONS: The assessrnent of LAA function by TEE may be helpful to discriminate the high risk group for the potential ischemic stroke in patients with nonrheumatic atrial firillation.
Atrial Appendage* ; Atrial Fibrillation* ; Echocardiography, Transesophageal* ; Embolism ; Heart ; Heart Atria ; Humans ; Relaxation ; Stroke* ; Thrombosis ; Tooth

Humans ; Atrial Fibrillation/surgery* ; Left Atrial Appendage Closure ; Heart Atria/surgery* ; Catheter Ablation/methods* ; Atrial Appendage/surgery* ; Treatment Outcome

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.
Agar ; Animals ; Atrial Appendage ; Diverticulum ; Embryonic Structures ; Fetus ; Heart ; Heart Atria ; Isomerism ; Mice* ; Venous Valves

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.
Agar ; Animals ; Atrial Appendage ; Diverticulum ; Embryonic Structures ; Fetus ; Heart ; Heart Atria ; Isomerism ; Mice* ; Venous Valves

OBJECTIVES: This study evaluates the change of the left atrial appendage function before and after electrical cardioversion to understand the mechanism involved in systemic thromboembolism of atrial fibrillation. BACKGROUND: Systemic thromboembolism associated with electrical cardioversion of atrial fibrillation is thought to originate from the left atrium or left atrial appendage, or both.However, the mechanism involved is poorly understood. METHOD: We studied left atrial appendage function funcction with transesophageal echocardiography in 15 patients with atrial fibrillation before and after successful electrical cardioversion. We measured left atrial appendage emptying and filling velocities and left atrial appendage areas. Also we analysed the characteristic Dopper flow pattern of LAA. RESULT: Left atrial appendage emptying velocities before cardioversion were greater in patients without(32.0+/-13.2cm/sec) than in those with(21.4+/-7.6cm/sec) spontaneous echo contrast(SEC). Furthermore emptying velocities after cardioversion were significantly reduced group with (21.4+/-7.6 vs 12.2+/-9.6, p<0.05) and the groupwithout(32.0+/-13.2 vs 18.1+/-10.2, p<0.05)SEC. CONCLUSION: After electrical cardioversion for atrial fibrillation left atrial appendage function is impaired. These observations suggest that stunned left atrial appendage after cardioversion may predispose to thrombus formation, which may play a role in the mechanism involved in the occurrence of thromboembolism after cardioversion.
Atrial Appendage* ; Atrial Fibrillation* ; Echocardiography, Transesophageal* ; Electric Countershock* ; Heart Atria ; Humans ; Thromboembolism ; Thrombosis

In mitral valve disease, mural thrombus in the left atrium is common, particulary in the atrial appendage in patients with atrial fibrillation. Occasionally, the angiographic sign of "neovascularity" and "fistula" in the region of the left atrial appendage during coronary arteriography has been reported to indicate the presence of thrombus in the left atrium, which might not even be revealed by transthoracic two-dimensional echocardiography. We observed coronary neovascularity and fistula formation in two pateints with mitral stenosis and these findings were due to organized mural thrombus that was adherent to the wall of the left atrial appendage. So we report 2 cases with brief review of literature.
Angiography ; Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Fistula* ; Heart Atria ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Thrombosis*

In mitral valve disease, left atrial thrombus is a common finding, particularly in left atrial appendage in patients with atrial fibrillation. But free-floating thrombus is rare. Nevertheless, it is an important and potentially fatal complication because it can cause sudden arrest by obstucting the mitral orifice, or serious cerebral and peripheral embolic events. Therefore it is important to early detect such lesions. It usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation. We report the clinical and echocardiographic findings in a patient with left atrial free-floating thrombus who had two episodes of cerebral embolic event.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Heart Atria ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Thrombosis

To evaluate the volume and function of left atrium and left atrial appendage in patients with atrial fibrillation by three-dimensional transesophageal echocardiography and transthoracic echocardiography.
 Methods: A total of 112 patients with atrial fibrillation were divided into two groups: a paroxysmal atrial fibrillation (ParAF) group (n=80) and a persistent atrial fibrillation (PerAF) group (n=32). Control group was people without atrial fibrillation (n=40). Clinical data of the participants were collected. Left atrial dimension (LAD), left atrial volume (LAV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were measured by transthoracic echocardiography, while left atrial appendage peak emptying flow velocity (LAAeV), left atrial appendage peak filling flow velocity (LAAfV), left atrial appendage maximum volume (LAAVmax) and left atrial appendage minimum volume (LAAVmin) were measured by three-dimensional transesophageal echocardiography. Left atrial volume index (LAVI), left ventricular ejection fraction (LVEF) and left atrial appendage ejection fraction (LAAEF) were calculated. 
 Results: Compared with the control group, LAAEF, LAAeV and LAAfV in the ParAF group were decreased obviously, while LAD, LAV, LAVI, LAAVmax and LAAVmin in the ParAF group were increased obviously (P<0.05). Compared with the ParAF group, LAAEF, LAAeV and LAAfV in the PerAF group were also decreased obviously, and LAD, LAV, LAVI, LAAVmax and LAAVmin in the ParAF group were also increased obviously (P<0.05). There was no statistically significant difference in LVEDV, LVESV, LVEF between the ParAF group and the PerAF group (P<0.05).
 Conclusion: Left atrium and left atrial appendage were enlarged and the function of left atrial appendage was declined in patients with AF, and the changes were more obvious in patients with PerAF compared with patients with ParAF by three-dimensional transesophageal echocardiography and transthoracic echocardiography.
Atrial Appendage ; physiopathology ; Atrial Fibrillation ; physiopathology ; Echocardiography, Transesophageal ; Heart Atria ; physiopathology ; Humans

OBJECTIVES: Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function. METHODS: A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m², peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients. RESULTS: The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´. CONCLUSIONS The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.
Humans ; Atrial Fibrillation ; Atrial Appendage ; Heart Atria/diagnostic imaging* ; Hypertension/complications* ; Diastole

Congenital intrapericardial left atrial appendage aneurysms (LAAA) are very rare. Most cases are asymptomatic and this malady is generally incidentally diagnosed in older patients. LAAAs are usually accompanied with supraventricular arrhythmias and life-threatening systemic embolism. Complete surgical correction is recommended immediately after the diagnosis to prevent significant complications, and even for the asymptomatic patients. We report here on the case of a 45-year-old man who presented with cerebral embolism due to LAAA. The patient was successfully treated with a resection of the aneurysm.
Aneurysm ; Arrhythmias, Cardiac ; Atrial Appendage ; Embolism ; Heart Atria ; Humans ; Intracranial Embolism ; Middle Aged ; Stroke