Left atrial appendage inversion: First computational study to shed light on the phenomenon
Inversion of the left atrial appendage is a rare phenomenon, which may occur during the de-airing maneuvers associated to routinely performed surgery procedures, such as cardiopulmonary bypass or left ventricular assist device implantation. In this case, the body of the inverted appendage can obstru...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-02-01
|
| Series: | Heliyon |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024026604 |
| _version_ | 1797267636219805696 |
|---|---|
| author | Danila Vella Giulio Musotto Andrew Cook Giorgia Maria Bosi Gaetano Burriesci |
| author_facet | Danila Vella Giulio Musotto Andrew Cook Giorgia Maria Bosi Gaetano Burriesci |
| author_sort | Danila Vella |
| collection | DOAJ |
| description | Inversion of the left atrial appendage is a rare phenomenon, which may occur during the de-airing maneuvers associated to routinely performed surgery procedures, such as cardiopulmonary bypass or left ventricular assist device implantation. In this case, the body of the inverted appendage can obstruct the mitral valve leading to severe complications. The mechanisms are still poorly known, and more specific studies are needed to better understand its causes and identify mitigating strategies. The current study attempts to gain a better comprehension of the conditions and the factors favourable to left atrial appendage inversion. Four patient specific appendage morphologies, obtained from computerised tomography and representative of the main typologies commonly used for the appendage classification (chicken wing, cactus, cauliflower, and windsock), were used for the study. The numerical models were subjected to the same loading pattern, made of subsequent different pressure curves.Results show that the morphologies invert and recover their original anatomical configuration at different pressure loads, indicating that their tendency to invert is associated to their specific morphological features. Moreover, the analysis highlights that, although restoring the physiological left atrium pressure is not sufficient to induce appendage recovery, pressures well below the ventricular ones can induce the return to the natural configuration.All models recovered the anatomical configuration at pressures well below the ventricular pressure (about 100 mmHg), suggesting that basic trans-catheter maneuvers, e.g. producing temporary mitral regurgitation, could be attempted to correct the appendage configuration, prior to opt for more invasive surgical approaches. |
| first_indexed | 2024-03-07T22:00:33Z |
| format | Article |
| id | doaj.art-db013bbe46aa4c18a266d99eed16d47f |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-25T01:19:44Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-db013bbe46aa4c18a266d99eed16d47f2024-03-09T09:28:43ZengElsevierHeliyon2405-84402024-02-01104e26629Left atrial appendage inversion: First computational study to shed light on the phenomenonDanila Vella0Giulio Musotto1Andrew Cook2Giorgia Maria Bosi3Gaetano Burriesci4Bioengineering Group, Ri.MED Foundation, Palermo, ItalyBioengineering Group, Ri.MED Foundation, Palermo, Italy; Department of Engineering, University of Palermo, ItalyUCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United KingdomUCL Mechanical Engineering, University College London, London, United KingdomBioengineering Group, Ri.MED Foundation, Palermo, Italy; UCL Mechanical Engineering, University College London, London, United Kingdom; Corresponding author at: UCL Mechanical Engineering, University College London, London, United Kingdom.Inversion of the left atrial appendage is a rare phenomenon, which may occur during the de-airing maneuvers associated to routinely performed surgery procedures, such as cardiopulmonary bypass or left ventricular assist device implantation. In this case, the body of the inverted appendage can obstruct the mitral valve leading to severe complications. The mechanisms are still poorly known, and more specific studies are needed to better understand its causes and identify mitigating strategies. The current study attempts to gain a better comprehension of the conditions and the factors favourable to left atrial appendage inversion. Four patient specific appendage morphologies, obtained from computerised tomography and representative of the main typologies commonly used for the appendage classification (chicken wing, cactus, cauliflower, and windsock), were used for the study. The numerical models were subjected to the same loading pattern, made of subsequent different pressure curves.Results show that the morphologies invert and recover their original anatomical configuration at different pressure loads, indicating that their tendency to invert is associated to their specific morphological features. Moreover, the analysis highlights that, although restoring the physiological left atrium pressure is not sufficient to induce appendage recovery, pressures well below the ventricular ones can induce the return to the natural configuration.All models recovered the anatomical configuration at pressures well below the ventricular pressure (about 100 mmHg), suggesting that basic trans-catheter maneuvers, e.g. producing temporary mitral regurgitation, could be attempted to correct the appendage configuration, prior to opt for more invasive surgical approaches.http://www.sciencedirect.com/science/article/pii/S2405844024026604LAA inversionFinite element analysisLAA morphologyLAA prolapseLAA eversion |
| spellingShingle | Danila Vella Giulio Musotto Andrew Cook Giorgia Maria Bosi Gaetano Burriesci Left atrial appendage inversion: First computational study to shed light on the phenomenon Heliyon LAA inversion Finite element analysis LAA morphology LAA prolapse LAA eversion |
| title | Left atrial appendage inversion: First computational study to shed light on the phenomenon |
| title_full | Left atrial appendage inversion: First computational study to shed light on the phenomenon |
| title_fullStr | Left atrial appendage inversion: First computational study to shed light on the phenomenon |
| title_full_unstemmed | Left atrial appendage inversion: First computational study to shed light on the phenomenon |
| title_short | Left atrial appendage inversion: First computational study to shed light on the phenomenon |
| title_sort | left atrial appendage inversion first computational study to shed light on the phenomenon |
| topic | LAA inversion Finite element analysis LAA morphology LAA prolapse LAA eversion |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024026604 |
| work_keys_str_mv | AT danilavella leftatrialappendageinversionfirstcomputationalstudytoshedlightonthephenomenon AT giuliomusotto leftatrialappendageinversionfirstcomputationalstudytoshedlightonthephenomenon AT andrewcook leftatrialappendageinversionfirstcomputationalstudytoshedlightonthephenomenon AT giorgiamariabosi leftatrialappendageinversionfirstcomputationalstudytoshedlightonthephenomenon AT gaetanoburriesci leftatrialappendageinversionfirstcomputationalstudytoshedlightonthephenomenon |