HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland.
Heart Lung Circ. 2021 Jul;30(7):1014-1022. doi: 10.1016/j.hlc.2020.12.006. Epub 2021 Feb 10.
The left atrial appendage (LAA) is a heart structure with known prothrombogenic and pro-arrhythmogenic properties.
The aim of this study was to evaluate the specific anatomy of the LAA and to create a simple classification system based on the shape of its body.
This study investigated 200 randomly selected autopsied human hearts (25.0% females, 46.6±19.1 years old). Three (3) types of LAAs were distinguished: the cauliflower type (no bend, limited overall length, compact structure [36.5%]); the chicken wing type (substantial bend in the dominant lobe [37.5%]), and the arrowhead type (no bend, one dominant lobe of substantial length [26.0%]). Additional accessory lobes were present in 55.5% of all LAAs. Significant variations between category types were noted in LAA length (chicken wing: 35.7±9.8 mm, arrowhead: 30.8±10.1 mm, cauliflower: 22.3±9.6 mm [p<0.001]) and in the thickness of pectinate muscles located within the LAA apex (arrowhead: 1.2±0.7 mm; cauliflower: 1.1±0.6 mm; chicken wing: 0.9±0.6 mm [p<0.001]). Left atrial appendage volume and orifice size were not affected by the type of LAA shape. The age of the donor was positively correlated with LAA volume (r=0.29, p=0.005), body length (r=0.26, p=0.012), and area of the orifice (r=0.36, p<0.001). Donors with an oval LAA orifice were significantly older than those with round orifices (50.2±16.6 vs 43.7±20.4 years [p=0.014]) and had significantly heavier hearts (458.2±104.8 vs 409.6±114.1g [p=0.002]).
This study delivered a new simple classification system of the LAA based on its body shape. An increase in age and heart weight was associated with LAA enlargement and a more oval-shaped orifice. Results of current study may help to estimate the different thrombogenic properties associated with each LAA type and be an assistance during planning and performing interventions on LAA.
左心耳（LAA）是一种具有已知促血栓形成和致心律失常特性的心脏结构。
本研究旨在评估 LAA 的特定解剖结构，并基于其主体形状创建一个简单的分类系统。
本研究调查了 200 个随机选择的尸检人心（25.0%为女性，年龄 46.6±19.1 岁）。区分出三种（3）种 LAA 类型：菜花型（无弯曲，整体长度有限，结构紧凑[36.5%]）；鸡翅型（主导叶有明显弯曲[37.5%]）和箭头型（无弯曲，一个主导叶长度较大[26.0%]）。所有 LAA 中，附加附属叶的存在率为 55.5%。在 LAA 长度（鸡翅：35.7±9.8mm，箭头：30.8±10.1mm，菜花：22.3±9.6mm [p<0.001]）和位于 LAA 顶点的梳状肌厚度（箭头：1.2±0.7mm；菜花：1.1±0.6mm；鸡翅：0.9±0.6mm [p<0.001]）方面，类别类型之间存在显著差异。LAA 形状类型不影响 LAA 体积和口大小。供体的年龄与 LAA 体积呈正相关（r=0.29，p=0.005）、体长（r=0.26，p=0.012）和口面积（r=0.36，p<0.001）。LAA 口为椭圆形的供体明显比圆形供体年龄大（50.2±16.6 岁比 43.7±20.4 岁 [p=0.014]），且心脏重量明显较重（458.2±104.8g 比 409.6±114.1g [p=0.002]）。
本研究基于 LAA 主体形状提供了一种新的简单分类系统。年龄和心脏重量的增加与 LAA 增大和更椭圆形的口相关。目前研究的结果可以帮助估计与每种 LAA 类型相关的不同血栓形成特性，并在 LAA 规划和干预时提供帮助。
