Intussusception of the Left Atrial Appendage: A Systematic Review

Background

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.

Methods

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.

Results

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%).

Conclusions

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.