Scagliola Riccardo, Passerone Giancarlo, Balbi Manrico
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Cardiothoracic Surgery Unit, University of Genoa, Genoa, Italy.
CJC Open. 2025 May 2;7(6):768-776. doi: 10.1016/j.cjco.2025.04.002. eCollection 2025 Jun.
Intussusception of the left atrial appendage (LAA) is an uncommon and often underrecognized finding; poor knowledge of this condition is still widespread in clinical practice. A systematic review was carried out to provide a comprehensive and updated overview on this condition.
A bibliographic search using major databases resulted in 25 case reports meeting the criteria. Included records reported data from patients aged > 18 years with a diagnosis of LAA intussusception, determined either intraoperatively or incidentally by imaging tools, and findings on baseline demographics, clinical findings, imaging diagnostic workup, and management.
For the 25 patients included, the median age was 54 years, with a predominance of female sex (53%). Most of intussuscepted LAA cases were disclosed intraoperatively (60%) or incidentally by imaging tools (20%) in the absence of associated clinical findings. All reported cases underwent transoesophageal echocardiography, and in most, LAA intussusception was confirmed by intraoperative inspection (44%) or further imaging (23%). In most cases, LAA intussusception was resolved interventionally (60%). In fewer subjects, LAA eversion occurred spontaneously (32%), and in the remaining cases, a conservative approach was adopted (8%).
This study presents the largest systematic review to date of an adult patient population with a diagnosis of intussuscepted LAA. Regardless of the various etiologies and clinical manifestations associated with LAA intussusception, physicians should be aware of the possibility of this rare entity, to provide timely recognition and thereby avoid misleading diagnoses and enable appropriate decision-making.
左心耳套叠是一种罕见且常未被充分认识的情况；在临床实践中，对这种病症的了解仍然普遍不足。进行了一项系统综述，以提供关于这种病症的全面且最新的概述。
使用主要数据库进行文献检索，得到25篇符合标准的病例报告。纳入的记录报告了年龄大于18岁、诊断为左心耳套叠患者的数据，这些诊断通过手术中确定或通过成像工具偶然发现，以及关于基线人口统计学、临床发现、成像诊断检查和治疗的结果。
对于纳入的25名患者，中位年龄为54岁，女性占多数（53%）。大多数套叠的左心耳病例在手术中被发现（60%）或通过成像工具偶然发现（20%），且无相关临床发现。所有报告的病例均接受了经食管超声心动图检查，大多数情况下，左心耳套叠通过术中检查（44%）或进一步成像（23%）得以确诊。在大多数病例中，左心耳套叠通过干预得到解决（60%）。较少患者中，左心耳翻转自发发生（32%），其余病例则采取保守方法（8%）。
本研究呈现了迄今为止对诊断为套叠性左心耳的成年患者群体的最大规模系统综述。无论与左心耳套叠相关的各种病因和临床表现如何，医生都应意识到这种罕见病症的可能性，以便及时识别，从而避免误诊并做出适当决策。
