ArticleInterdisciplinary cardiovascular and thoracic surgery2025
Speech bubble sign - insights regarding incomplete left atrial appendage closure via electrocardiography-synchronized computed tomography in robotic surgery cases.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Endocardial obliterative left atrial appendage closure by inverted purse-string plication.JTCVS techniques · 2026Article
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14 authors.
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Abstract
objectivesIn atrial fibrillation (AF), surgical management of the left atrial appendage (LAA) is crucial to prevent stroke. However, incomplete closure poses a residual embolic risk.
methodsWe retrospectively analyzed patients who underwent LAA closure using a continuous polypropylene suture technique during mitral valve surgery with the da Vinci system. Closure completeness was assessed via electrocardiogram-gated computed tomography (CT), and 3 D imaging was used to localize incomplete sites.
resultsOf 125 patients, 100 underwent postoperative CT. Complete closure (cLAA) was achieved in 76%, while 24% had incomplete closure (iLAA), typically at the mitral valve junction or suture start. These showed a characteristic "speech bubble" appearance. iLAA was associated with tricuspid valve repair and low V1 f-wave amplitude. Stroke rates were similar between groups over 24 months.
conclusionsIncomplete LAA closure occurred in 24% of cases despite direct visualization using robotics. Anatomical factors likely contribute more than technique alone. For high-risk patients with long-standing AF, techniques such as lumen crushing or external clips may enhance closure success. Further refinements are needed to improve the reliability of internal LAA closure methods.
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