The left atrial appendage (LAA) is a structure in the left upper chamber of the heart. When some patients develop atrial fibrillation(AF) (an irregular heart beat), blood flow within the left heart chamber and especially that in the LAA becomes sluggish. This can lead to an increased risk of clot formation within the LAA. Occasionally, these clots can migrate and travel via the bloodstream and lodge themselves into blood vessels causing disastrous consequences. If the blood vessel obstructed is in the brain, stroke occurs, If the clots lodge into blood vessels of the intestine or limbs, organ damage ensues
This is the reason blood thinners are offered to patients once AF occurs.
Unfortunately, some patients are unable to take blood thinners or may have experienced severe bleeding from these medications. An alternative option for these patients is the LAA closure procedure. 90% of clots in patients with AF develop within the LAA. Therefore, closing off the LAA was done by cardiac surgeons when they operate on patients. We can now do this without open surgery.
Pre-planning is done by transesohageal echocardiogram (ultrasound) through the mouth or a computed tomography of the heart (CT scan). These are done to determine the shape and size of the LAA. The patient is then brought to the catheterization laboratory for the procedure. The procedure is done under general anesthesia with ultrasound and X-ray guidance, A small tube is first placed in the right thigh. Through this, a transseptal passage is made using a specialized catheter and needle to traverse the wall which separates the left and right atrium. After this a specialized device (LAA occlude) is placed within the LAA and plugs up the opening of the LAA. After some time, tissue grows over the LAA opening and then closes this permanently. This would then reduce the chance of clot formation within the LAA. Most patients following this procedure can then be protected from stroke without the need of potent blood thinners.
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