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• W1972718824 abstract "We read the article by Kamohara and collesgues1Kamohara K. Popovic Z.B. Daimon D.M. Martin M. Ootaki Y. Akiyama et al.Impact of left atrial appendage exclusion on left atrial function.J Thorac Cardiovasc Surg. 2007; 130: 1639-1644Abstract Full Text Full Text PDF Scopus (21) Google Scholar regarding the short-term and midterm effects of left atrial appendage (LAA) occlusion on left atrial (LA) function with great interest. An atrial exclusion device was applied by means of thoracotomy in 19 mongrel dogs in sinus rhythm, and hemodynamic, as well as echocardiographic, data were recorded immediately and after 7 and 90 days. The authors found that LAA exclusion might affect LA reservoir function. We would like to congratulate the authors for their important study. However, there still remain the following questions:1When measuring the LA area by means of planimetry before LAA exclusion, was the LAA area included or excluded? If it was included, this might well explain the decrease in LA volume and area after LAA exclusion, as listed in Table 1. If the LAA area was not included, how do the authors then explain the decrease in LA area and volume?2There is a great variation in human LAA size.2Ernst G. Stöllberger C. Abzieher F. Veit-Dirscherl W. Bonner E. Bibus B. et al.Morphology of the left atrial appendage.Anat Rec. 1995; 242: 553-561Crossref PubMed Scopus (143) Google Scholar We do not know whether this is also true for the canine LAA. What was the size of the excluded LAAs, and was there any association between LAA size and the hemodynamic or Doppler measurements?3The LAA is known as an important site of natriuretic peptide secretion.3Stöllberger C. Schneider B. Finsterer J. Elimination of the left atrial appendage to prevent stroke or embolism? Anatomic, physiologic, and pathophysiologic considerations.Chest. 2003; 124: 2356-2362Crossref PubMed Scopus (90) Google Scholar Were serum levels of natriuretic peptides measured before the procedure and during follow-up? Did the authors observe weight gain caused by fluid retention after LAA occlusion?4It is known that in guinea pigs LAA exclusion leads to a decrease in cardiac output.4Massoudy P. Beblo S. Raschke P. Zahler S. Becker B.F. Influence of intact left atrial appendage on hemodynamic parameters of isolated guinea pig heart.Eur J Med Res. 1998; 310: 470-474Google Scholar If the investigated dogs are still alive, it would be very interesting to continue follow-up, measure cardiac output and functional parameters, and compare them with those from control dogs with the LAA left intact.5All hemodynamic and Doppler parameters were obtained in healthy dogs in sinus rhythm at rest. Because LAA occlusion is considered in patients with heart disease in atrial fibrillation, an increase in heart rate during exercise might well result in an inappropriate increase of the LA pressure because of impaired LA reservoir function. In conclusion, there is still no proof that LAA occlusion prevents stroke,5Almahameed S.T. Khan M. Zuzek R.W. Juratli N. Belden W.A. Asher C.R. et al.Left atrial appendage exclusion and the risk of thromboembolic events following mitral valve surgery.J Cardiovasc Electrophysiol. 2007; 18: 364-366Crossref PubMed Scopus (46) Google Scholar but hemodynamically, this procedure might even do harm and should therefore not be performed in patients with atrial fibrillation. Reply to the EditorThe Journal of Thoracic and Cardiovascular SurgeryVol. 134Issue 2PreviewWe appreciate the response of Drs Stöllberger, Schneider, and Finsterer to our work1 and thank them for their comments. Here are our responses to their specific questions: We disagree with their conclusion that hemodynamically LAA occlusion might even do harm and should therefore not be performed in patients with atrial fibrillation. There is no solid evidence to suggest that exclusion of the LAA in patients with atrial fibrillation does harm. In fact, there is good evidence suggestive to the contrary2,3; much of this has been gathered from patients undergoing mitral valve surgery or surgical ablation. Full-Text PDF" @default.
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• W1972718824 title "Leave the left atrial appendage untouched for stroke prevention!" @default.
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