Key result
Anatomical examination of 200 autopsied human hearts identified three right atrial appendage vestibule isthmuses with significant variations in height and wall thickness (p<0.001).
Why the study?
The right atrial appendage vestibule may be a target for invasive transcatheter procedures, but its detailed topographical anatomy and adjoining isthmuses had not been described.
Observational (n=200)
This detailed anatomical description of the right atrial appendage vestibule and its isthmuses highlights substantial structural variability that may be important for planning transcatheter interventions.
RAA vestibule variants may affect transcatheter targeting; hypothesis-generating for in vivo procedural studies.
INTRODUCTION: The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. METHODS AND RESULTS: We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). CONCLUSIONS: This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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Słodowska et al. (2020) reported an observational. Anatomical examination was evaluated on Dimensions and thickness of the right atrial appendage vestibule and its isthmuses. Anatomical examination of 200 autopsied human hearts identified three right atrial appendage vestibule isthmuses with significant variations in height and wall thickness (p<0.001).
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