Congenital Hypoplasia or Absence of Left Atrial Appendage-Exploring Its Imaging Diagnosis and Clinical Significance
Objective To explore the imaging manifestations of hypoplastic left atrial appendage(LAA)and absence of LAA,and to understand the clinical significance of these congenital cardiac malformations.Methods Five patients with absent left atrial appendage diagnosed by imaging from October 2018 to December 2021 in our hospital were collected.All of them had undergone cardiac CT angiography(CTA),transesophageal echocardiography(TEE),and plain CT scan of the pulmonary.Their imaging and clinical data were retrospectively analyzed.Results Of the 5 cases of esophageal ultrasound,3 cases reported no left atrial appendage display,and 2 cases reported a very small left atrial appendage with spontaneous visualization.Of the 5 cases of pulmonary vein CTA,1 case showed no left atrial appendage visualization in both the pulmonary vein and delayed phases;2 cases showed no left atrial appendage visualization in the pulmonary vein phase,with minimal contrast agent filling of the left atrial appendage in the delayed phase;2 cases showed linear contrast agent filling of the left atrial appendage in the pulmonary vein phase,with slightly expanded left atrial appendage visualization in the delayed phase.All 5 cases of lung CT plain scan could show minimal left atrial appendage anatomy in the normal position.All patients had normal coronary sinus structures,with varying degrees of dilation of the vessel diameter.The CHA2DS2-VASc stroke scores of the 5 atrial fibrillation patients were 7,7,6,7,and 6,all of whom were high-risk stroke patients.4 patients had recurrent lacunar cerebral infarction,and 1 patient had a large area of cerebral infarction.Conclusion In this group of 5 patients with a preliminary diagnosis of absence of the left atrial appendage based on imaging,combined with chest CT scans,it was found that there were similar extremely small finger-like structures in the left atrial pulmonary sulcus,with well-developed internal pectinate muscles and extremely small residual lumens.Therefore,it is questionable whether similar cases represent true anatomical absence of the left atrial appendage,and it seems more appropriate to attribute them to left atrial appendage hypoplasia.ln patients with atrial fibrillation and hypoplastic left atrial appendage,clinical thrombotic events have not decreased,and their clinical stroke risk may only be related to the CHA2DS2-VASc score.
Hypoplastic LAA:Absence of the LAAThromboembolismMultimodality imaging
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