A highly-detailed anatomical study of left atrial auricle as revealed by in-vivo computed tomography

Figures

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  Fig. 1. Cinematic rendering (A), Axial reconstruction (B) and Volume Rendering cardiac-CT images (D–E), highlighting LAA main features and its anatomical landmarks. Thoracic axial section through LAA obtained from Visible Human Server (C; courtesy of Prof. R.D. Hersch. Ecole Polytechnique Federale de Lousanne (EPFL). Switzerland. Visible Human Web Server. http://visiblehuman.epfl.ch).

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  Fig. 2. (A–D). Cinematic rendering (A,C) and multiplanar (B,D) CT reconstruction images of “chicken wing” LAA morphology.

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  Fig. 3. (A–D). Cinematic rendering (A,C) and multiplanar (B,D) CT reconstruction images of “cactus” LAA morphology.

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  Fig. 4. (A–C). Cinematic rendering (A) and multiplanar (B,C) CT reconstruction images of “windsock” LAA morphology.

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  Fig. 5. (A–C). Cinematic rendering (A) and multiplanar (B,C) CT reconstruction images of “cauliflower” LAA morphology.

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  Fig. 6. Muscular trabeculations in LAA. Trabeculations are indicated by violet arrows in multiplanar CT reconstruction A-E. Pectinate muscles in LAA are indicated by red arrows in multiplanar CT reconstruction F–H. Fig. 6I is an ex-vivo endoscopic image wich presents pectinate muscles of LAA. Fig. 6I is a courtesy of Prof. Iaizzo, Visible Heart Laboratory Atlas of Human Cardiac Anatomy. Minnesota University,http://www.vhlab.umn.edu/atlas. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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  Fig. 7. Multiple transesophageal ultrasound left atrium B-Mode (A,B,C) and 3D (D) views obtained at mid-esophageal level show a rare case of congenital absence of the LAA.

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  Fig. 8. Gestational development of the atrial auricles. A. Early chamber formation in the end of the fifth gestational week studied by Scanning Electron Microscopy. B. In the sixth week, the chambers are pronounced. C. In the seventh week, an adult-like LAA can be seen (white arrow) but the resemblance is transient only. D. In early fetal development, the left atrial appendage is proportionally large. All images are adapted from Oostra et al., 2007 [39] with permission. “Stage” refers to the Carnegie staging (1–23) of human embryos. LA, left atrium; LV, left ventricle; OFT, outflow tract; PT, pulmonary trunk; RA, right atrium; RV, right ventricle.

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  Fig. 9. Cardiac magnetic resonance images of LAA thrombi in a 50-year old man in sinus rhythm with previous catheter ablation of atrial fibrillation (vertical long axis view, A and A′) and in a 84-year old women with permanent atrial fibrillation (four chamber view, B and B′).

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  Fig. 10. (A–D): A case of LAA occlusion for stroke prophylaxis in a patient with non-valvular atrial fibrillation and high risk of cardioembolic stroke. Multiplanar CT reconstruction Images show a LAA occluding device (yellow arrows) appearing only partially thrombosed (blue arrow). Pink asterisks show a partially still open LAA. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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  Fig. 11. (A–E). Volume rendering (A,B) and Axial reconstruction (C,D) CT images highlighting right and LAA main features and its anatomical landmarks. Axial section through human thorax showing LAA and RAA (E; courtesy of Prof. R.D. Hersch. École Polytechnique Federale de Lousanne (EPFL). Switzerland. Visible Human Web Server. http://visiblehuman.epfl.ch).