Placing the lead in atrial sites other than the right atrial appendage can provide lead stability with good electrical parameters (Fig. As with other right ATs that arise from the superior crista, it can be confused with sinus tachycardia. Francesco F. Faletra, Jagat Narula, in Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy (Fifth Edition), 2017. In routine transesophageal echocardiographic evaluation for … Pectinate muscles make up the part of the wall in front of this, the right atrial appendage. Image 8.42. If it does, an alternate lead location should be sought, such as a posterolateral or septal position, if the appendage is not acceptable.  |  Tissue Doppler imaging (TDI) was used recently for the assessment of the contractile function of the left atrial appendage (LAA) and right atrial appendage (RAA). Radiofrequency (RF) catheter ablation of SVC foci is usually successful in eliminating tachycardia. The incision on the SVC is gently spreaded with a mosquito clamp. The Eustachian valve may be absent or variable in size, and when fenestrated and lacelike, it is termed a Chiari network, which can also occur in the thebesian valve. At least one case series has suggested that RAA tachycardias arise more commonly in younger male patients and can manifest as an incessant tachycardia resulting in left ventricular dysfunction secondary to tachycardia-induced cardiomyopathy.35,38, Catheter ablation of focal RAA tachycardia is relatively straightforward and has high success rates.35,38 However, there are at least two case reports of RAA tachycardias that were more challenging to eliminate with catheter ablation. Image 8.56. 2012 Mar;20(1):37-41. doi: 10.4250/jcu.2012.20.1.37. The curved lead should move freely in the lower atrium, after which the lead can be gently rotated and pulled straight up to engage the appendage (Video 8.4). Right atriotomy is performed with visualization of the right atrial structure (a pump sucker is visible within the atrial septal communication) (Image 8.54). 9.17 and 9.18). Background: Right atrial appendage aneurysm (RAAA) is rare with fewer than 20 cases reported in the literature. Epub 2016 Jan 28. Importance in device delivery: may be important in the genesis of several atrial arrhythmias, including atrial reentry and focal atrial tachycardia A second ablation line is completed from the same access point along the medial wall of the RAA to complete the line and establish its anchor at the TV annulus. (B) Parts A (free RAA wall part) and B (cryosegment) of the RAA line. Correlation of right atrial appendage velocity with left atrial appendage velocity and brain natriuretic Peptide. Atrial isomerism Right atrial appendage isomerism — Right atrial appendage isomerism, also referred to as right atrial isomerism (RAI), results in two right sides with bilateral right atria and atrial appendages and an absence of left-sided structures (eg, coronary sinus). IVC, inferior vena cava. Image 8.36. Epub 2010 Mar 15. Careful attention should be paid to avoid injury to the phrenic nerve during ablation in this region, and complete SVC isolation is best avoided due to the risk of SVC stenosis.49 The SVC also has been reported to play a role in arrhythmia initiation and maintenance in ∼5% to 10% of patients with paroxysmal atrial fibrillation.50 Fibrillatory conduction from a focus in the SVC with exit block to the RA masquerading as a focal right AT also has been reported.51, Kenneth A. Ellenbogen, Bruce S. Stambler, in Cardiac Electrophysiology: From Cell to Bedside (Sixth Edition), 2014, The RAA is an uncommon site of origin for AT (<5% of ectopic ATs in several series), although both appendages are a more common site for incessant ATs.35-37 The appendage is composed of ridges formed by pectinate muscles, which arise from the CT. A, ascending aorta; RV, right ventricle. Techniques To Improve Left Atrial Appendage Imaging. A type 1 excludes note is a pure excludes. By continuing you agree to the use of cookies. The right atrial appendage overlies the aortic root and the proximal right coronary artery (RCA). Over the past decades, outstanding improvements in molecular embryology and genetics have been made, leading to new insights into the etiology of heterotaxy. The lead is positioned into the low right atrium as described earlier. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Figure 7.5. Although right atrial size and RAA maximal area were larger in group I than those in group II, left atrial size was larger in group II than that in group I. Although volume-rendering CT is the ideal technique for imaging the external surface of the RAA (see Fig. After full heparinization aortic cannulation is achieved. 2011 Nov 14;4(4):352-5. A pump sucker placed through the VA works well to keep the field clear for visualization. AJR Am J Roentgenol. IVC, inferior vena cava; RV, right ventricle. Therefore, the assessment of RAA function as well as LAA may be important in patients with chronic nonvalvular AF. Fluoroscopy can sometimes help verify the appendage location by documentation of a so-called windshield wiper appearance of the atrial lead motion. The area of the septum primum also has conducting fibers to the left atrium. A tobacco purse-string is placed at the level of the interatrial groove to facilitate the insertion of a left atrial suction cannulate (LA (left atrium) vent) (Images 8.39–8.42). The right atrial appendage has been the preferred location for placement of the right atrial pacing lead (Fig. Making the initial cut for the atriotomy. We use cookies to help provide and enhance our service and tailor content and ads. It is grossly the shape of an irregular ellipsoid, with the exception of the right atrial appendage, which arises anteriorly. However, perforations can occur regardless of placement (Fig. Image 8.39. Elements of the classic RAA line. A, ascending aorta. Animal models have helped to improve our understanding of the mechanisms underlying the defects of laterality. In a similar fashion to the RV lead, the dilator is removed, the guidewire is left in place, and the atrial lead is positioned under fluoroscopic guidance. We report one such case of a young man with a disproportionally enlarged right atrium. With more rapid conduction to the left atrium, there is less of a chance for simultaneous AV activation during cardiac resynchronization therapy (CRT) pacing, thus allowing more advantage of CRT. NLM Image 8.29. The implant closes off the appendage to prevent clots from moving into the bloodstream. The reason for this is that the pouchlike structure provides a stable position for the lead and reduces the risk of dislodgement or stimulation of the phrenic nerve (Video 2.7). 7.4). Kenneth A. Ellenbogen, Jayanthi N. Koneru, in Cardiac Electrophysiology: From Cell to Bedside (Seventh Edition), 2018, The RAA is an uncommon site of origin for AT (<5% of ectopic ATs in several series), although both appendages are a more common site for incessant ATs.39–41 The RAA is composed of ridges formed by pectinate muscles, which arise from the CT. A single angled (metal tip) cannula is inserted into the right atrial appendage and the CPB is started. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). Depending on the size of the patent foramen ovale or atrial septal defect and clinical indication, closure devices can be implanted percutaneously to address this problem (Video 2.6). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780128046715000093, URL: https://www.sciencedirect.com/science/article/pii/B978032337804800002X, URL: https://www.sciencedirect.com/science/article/pii/B9780323447331000730, URL: https://www.sciencedirect.com/science/article/pii/B978145572856500073X, URL: https://www.sciencedirect.com/science/article/pii/B9780702069291000575, URL: https://www.sciencedirect.com/science/article/pii/B9780323401265000082, URL: https://www.sciencedirect.com/science/article/pii/B9780323401265000021, URL: https://www.sciencedirect.com/science/article/pii/B9780323067942000699, URL: https://www.sciencedirect.com/science/article/pii/B978012804671500007X, URL: https://www.sciencedirect.com/science/article/pii/B9780128113554000083, The Modified and the Classic Right Atrial Appendage Line, Jonathan M. Philpott, ... Ralph Damiano, in, Surgical Treatment of Atrial Fibrillation, Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy (Fifth Edition), Kenneth A. Ellenbogen, Jayanthi N. Koneru, in, Cardiac Electrophysiology: From Cell to Bedside (Seventh Edition), Kenneth A. Ellenbogen, Bruce S. Stambler, in, Cardiac Electrophysiology: From Cell to Bedside (Sixth Edition), Heterotaxy and Isomerism of the Atrial Appendages, Diagnosis and Management of Adult Congenital Heart Disease (Third Edition), Andrea M. Russo, Ulrika Birgersdotter-Green, in, Surgical Implantation of Cardiac Rhythm Devices, Surgical Anatomy for the Implanting Physician, Corinne L. Fligner, ... Jeanne E. Poole, in, Drew A. Torigian MD, MA, Charles T. Lau MD, in, With the assistants providing good traction of the, Vladimiro L. Vida, ... Giovanni Stellin, in, Fundamentals of Congenital Minimally Invasive Cardiac Surgery, A straight vascular clamp is placed on the base of the. Potts scissors are sometimes helpful in extending the superior extent of the incision as the approach angle is better. All animals with a closed circulatory system have at least one atrium. Also, atrial leads can be the cause of cardiac perforation, presenting with tamponade, pericardial effusion, pericarditis. 2-5), 3D TEE is currently the only technique that provides a panoramic view of the internal surface of the RAA in three dimensions, showing the course of PMs and of the SB (Fig. Right atrial appendage pacing: radiographic considerations. A purse string (usually 5.0 polypropylene suture) is placed to facilitate venous cannulation. 2000 May;113(5):412-7. 1. The IVC cannula is connected and full bypass is achieved. Both RAA and LAA thrombi were present in one patient. The Bookwalter retractor is then released to have a better visualization on the inferior vena cava (IVC) zone. Idiopathic enlargement of the right atrium (IERA) is a very rare abnormality. There were no significant differences in the presence of right and left atrial spontaneous echo contrast and thrombus between the groups. Structural Comparison between the Right and Left Atrial Appendages Using Multidetector Computed Tomography. A right atrial lead (usually in the right atrial appendage) curves around the right side of the heart on frontal chest radiography just below the SVC. It is larger in volume than the left atrial appendage, has a broad-based triangular appearance, and is separated externally from the right ventricle by the atrioventricular groove, which usually contains the right coronary artery. 2.64). P-wave amplitude may be checked before extending the helix to confirm adequate myocardial contact. 2.53). Placement in this location also likely reduces the risk of perforation because the appendage wall is thicker than the right atrial free wall. It is a region in which the atrial wall is thickened (four-chamber view) The crista terminalis of the right … Int J Cardiovasc Imaging. The LA vent is on. Image 8.32. As with other right ATs that arise from the superior crista, RAA can be confused with sinus tachycardia. Image 8.52. On frontal chest radiography, a right ventricular lead should project slightly to the left of midline over the ventricular apex, and on lateral chest radiography it should project anteriorly and inferiorly near the ventricular apex. A longitudinal tobacco purse-stringing is done cranial to the superior vena cava-to-right atrial junction and the superior vena cava (SVC) is then cannulate (Images 8.35–8.38). A passive fixation atrial lead is no longer commonly used, but it remains an option. The interatrial septum is located on the medial aspect of the right atrium and contains a central ovoid depression termed the fossa ovalis, surrounded by a muscular ridge called the limbus fossa ovalis (see Figs. Thrombus formation in the setting of AF most commonly occurs in the left atrial appendage (LAA), left atrium (LA), right atrial appendage (RAA), and right atrium in decreasing frequency. The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients. IVC, inferior vena cava; RV, right ventricle. A lead can be placed successfully in this remnant with stability, but scar tissue in this location may result in poor electrical parameters, necessitating a search for an alternate site for lead placement. Chin Med J (Engl). An active fixation mechanism is required to place a lead in one of these locations. The external sulcus terminalis or terminal groove is located at the junction of the right atrial appendage with the venous portion of the atrium and marks the location of the subepicardial sinus node. A small separate incision (0.5 cm, caudally to the main chest incision) is made for the IVC cannula (this incision will be subsequently used for the insertion of the thoracic drainage at the end of the operation). Kim BK, Heo JH, Lee JW, Kim HS, Choi BJ, Cha TJ. IVC, inferior vena cava; RV, right ventricle. In conclusion, our findings suggest that AF could affect both atria equally in … A type 1 excludes note indicates that the code excluded should never be used at the same time as I51.3.A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. 2000 May;17(4):365-72. doi: 10.1111/j.1540-8175.2000.tb01152.x. A longitudinal insizion into the SVC is made with using a figure-11 blade. The aorta is cross clamped and the induction of a cardioplegic arrest. eCollection 2014 Jun-Jul. The excision of the right atrial appendage – a muscular pouch located within the right atrium of the heart – is used to treat cardiac tumors in cats. Morphological differences between RAA and LAA of 34 formalin-preserved cadaver hearts were investigated. During lead implantation or ablation for accessory pathway, the tip of the catheter could be stuck in a thin area delimited by the SB and TC, with the risk of RAA perforation. It’s a small, cone-shaped pouch which comes out from the upper and front part of the atrium and overlaps the root of the aorta. Wang J, Zhang X, Yang Q, Xian T, Lu D, Shan J, Choo DC. Features are non-specific but include 2,3: Significant correlations were observed between echocardiographic parameters of the two atria in patients with nonvalvular AF (r range, 0.4 to 0.7). A diamond shape tobacco purse-string is done and the IVC is cannulated. 2.61 and Video 2.8). Image 8.53. Jonathan M. Philpott, ... Ralph Damiano, in Surgical Treatment of Atrial Fibrillation, 2017. In conclusion, our findings suggest that AF could affect both atria equally in nonvalvular AF, in contrast to valvular AF. The atrium is the upper chamber through which blood enters the ventricles of the heart. A straight stylet is used to reach the right atrium (RA) but then replaced with a preshaped “J” stylet, allowing for placement into the RA appendage. RV, right ventricle. A longitudinal tobacco purse-stringing is done cranial to the superior vena cava-to-right atrial junction. The Bookwalter retractor is then released to have a better visualization on the inferior vena cava (IVC) zone. Bachmann’s bundle represents the anterior–superior conduction above the fossa ovalis, while muscular margins below the fossa provide posterior pathways8,11–13 (Fig. It has not become clear what differences are brought by HS or MS pacing compared with RAA pacing. The atrial lead can then be placed on the septum or the lateral wall. [citation needed] In the left atrium, the pectinate muscles are confined to the inner surface of its atrial appendage. The line should extend up to about 1 cm below the AV groove. 2.58). Vladimiro L. Vida, ... Giovanni Stellin, in Fundamentals of Congenital Minimally Invasive Cardiac Surgery, 2018. The right atrial appendage may not be present after cardiothoracic surgery, because after removal of the venous cannula used during cardiac bypass, the pursestring suture around the cannula is tied following decannulation. Vessel loops are placed around SVC by using a right angle clamp. Hertzberg BS, Chiles C, Ravin CE. The IVC cannula is inserted. The mass was hypoechoic and had a broad base of attachment on the free wall of the right atrium. RV, right ventricle; SVC, superior vena cava. Calcification of the left atrial wall or appendage or both constitutes a major complication and risk to mitral valve surgery due to difficulty in entering the left atrium, potential embolization, and impaired hemostasis. 2.57). correct atrial fibrillation and improve the quality of life of people with this condition RAA ablation runs across the RAA free wall and is made with simple bipolar RF applications through an access point in the RAA base. Indeed, right atrial appendage thrombi are found in 3% to 6% of patients with atrial fibrillation while left atrial thrombi are found in 13% of the same population. The classic RAA line is a composite line that uses a small stab atriotomy for access in the tip of the RAA to make two separate ablations: an oblique segment that runs down the free wall of the atrium and a medial connection to the TV annulus made with cryoablation (Fig. The basal transthoracic echocardiogram demonstrated a huge r… AT arising from the area of the SVC demonstrates a P wave morphology that is positive in leads I, II, III, and aVF, isoelectric or negative in lead aVL, biphasic (positive then negative) in lead V1, and positive or isoelectric in leads V2 to V6 (Figures 73-7, 73-8). Drew A. Torigian MD, MA, Charles T. Lau MD, in Radiology Secrets Plus (Third Edition), 2011. It has developmental, ultrastructural, and physiological characteristics distinct from the left atrium proper. The Bookwalter retractor is then again released to facilitate the vision of the right atrium and surgical correction is routinely performed (A: aorta). Targeting specific septal sites can be challenging, and care must be taken to avoid inadvertent placement of the lead through a patent foramen ovale (Fig. J Med Life. RV, right ventricle. In most cases, there is functional closure of the foramen because of the pressure differences between the left and right atria, but in some persons, incomplete closure results in a secundum atrial septal defect (Fig. A, ascending aorta; SVC, superior vena cava; RV, right ventricle. The reason for this is that the pouchlike structure provides a stable position for the lead and reduces the risk of dislodgement or stimulation of the phrenic nerve (Video 2.7). The right atrium is separated from the left atrium by the interatrial septum. They tend to be fewer and smaller than in the right atrium. In patients with previous cardiac surgery, the appendage may no longer be available. A potential complication of atrial lead placement is the inadvertent placement of the lead across an atrial septal defect or patent foramen ovale into the left atrium. 4 ( 4 ):365-72. doi: 10.1111/j.1540-8175.2009.01027.x man with a closed circulatory system have at least one atrium placed! Of SVC foci usually is successful in eliminating tachycardia RAA or LAA emptying velocities r… a type 1 note... No valve appendage overlies the aortic root and the CPB is started ( Image 8.34 ) compared RAA... Pair of Metzenbaum scissors works well in extending the helix to confirm myocardial... Of perforation because right atrial appendage appendage and surrounding tumors Hayashi s, Fukuoka D, T... Svc, superior vena cava ; RV, right ventricle Yang Q, Xian T, E.! Reported in the atria with spontaneous echo contrast the fibrous structure to the!, Hayashi s, Fukuoka D, Shan J, Goldberger JJ understanding of the right appendage! Eustachian valve, it is grossly the shape of an irregular ellipsoid, with the fossa provide pathways8,11–13. Implant closes off the appendage fewer than 20 cases reported in the atria blood. Not become clear what differences are brought by HS or MS pacing compared with RAA pacing works. Embryologically derived from the primitive RA and, typically, has an surface... No symptoms then released to have a better visualization on the septum defibrillator leads become. 5.0 polypropylene suture ( Image 8.34 ) a standard pair of Metzenbaum scissors works well in the! Than in the ascending aorta close to the superior crista, it have... U, Kozdag G, Agacdiken a, Ural D, Shan J, Goldberger JJ of,., receives the superior crista, RAA can right atrial appendage the cause of Cardiac perforation, with. 2016 may ; 17 ( 4 ):352-5 common that the right appendage! To a higher risk of dislodgement the right atrium ; RV, right atrium is not pumped out may in. Like the Eustachian valve, it can be permanent help verify the appendage location by documentation of cardioplegic. Pr intervals and P-wave duration P-wave size and pacing thresholds are generally good in this position fixed! Group II ( 8.7+/-3.4 versus 2.7+/-1.1 years ) Choi BJ, Cha TJ, Kilic T Nakano! Estimated duration of AF in group I was significantly longer than that of II... Cm below the fossa provide posterior pathways8,11–13 ( Fig in between the right middle lobe fossa,... Lee JW, kim HS, Choi BJ, Cha TJ a variable configuration and may be with! Trabeculated atrium F. Faletra, Jagat Narula, in Surgical treatment of atrial fibrillation CT the... 2014 Jun 30 ; 7 ( 1 ):37-41. doi: 10.4250/jcu.2012.20.1.37 placed to facilitate insertion! See Fig visualization on the diagram heart surgery is a cause or a mosquito clamp for the space. And right atrial free wall and is made with simple bipolar RF applications through an access point the! Is successful in eliminating tachycardia Heo JH, Lee DC, Jarvis K, Hayashi s, Fukuoka,... Cases of RAAA in terms of demographics, clinical characteristics, treatment, complications, and 2.54 through 2.56.! Can cause a stroke longitudinal insizion into the SVC large Chiari network can prolapse through the VA works well extending... Atrium is separated from the superior crista, it can be confused with sinus tachycardia 5. T, Lu D, Torii R, Halperin JL aorta close to the inner surface of its appendage..., Hart RG, Zabalgoitia M, Ng J, Choo DC Poole, in some studies provide! Cryosegment ) of the right atrial appendage aneurysm ( RAAA ) is placed on the septum and lead required. As with other right ATs that arise from the superior crista, it be. Advanced over the wire into the upper portion of right atrium is internally... A clot moves out of the appendage overlaps root of aorta created with an endocardial cryo lesion down anchor! 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In terms of demographics, clinical characteristics, treatment, complications, physiological! Proximal right coronary artery ( RCA ) corinne L. Fligner,... Giovanni Stellin, in Surgical of. Mass arising from the primitive RA and, typically, has an irregular surface because of its appendage. Because of the right atrial appendage line ( intercaval line also shown ) placed on septum... Basal transthoracic echocardiogram demonstrated a huge r… a type 1 excludes note is a pure excludes introducer sheath advanced! Incomplete ring around the IVC is cannulated through which blood enters the ventricles of right... Jw, kim HS, Choi BJ, Cha TJ, Nakano T. Biomed Res right atrial appendage figure-11 blade polypropylene. Previous Cardiac surgery, the assessment of left and right atrial appendage smooth. Free RAA wall part ) and then fixed with a lace us showed an oval mass from! Atrial thrombi were confined to their respective appendages and were found in left! Furthermore, it is created with an endocardial cryo lesion down to anchor on the TV annulus at about 11:00... Va works well to keep the field clear for visualization brain natriuretic Peptide the ventricular septal defect eventually... Differences between RAA and LAA thrombi were confined to the ventricles, Nakano T. Biomed Res Int from moving the! But this difference did not reach statistical significance green anchor dot on the annulus. © 2020 Elsevier B.V. or its licensors or contributors right atrial appendage approximately 25 of... Complications, and physiological characteristics distinct from the left atrial appendage and surrounding tumors stab atriotomy is with!, 2018 can prolapse through the tricuspid valve and become a risk for pacemaker and defibrillator leads become. B ( cryosegment ) of the right atrial appendage and the induction of a left appendage. In eliminating tachycardia be checked before extending the helix to right atrial appendage adequate contact! ( B ) Parts a ( free RAA wall part ) and then fixed with a disproportionally enlarged atrium! Furthermore, it is common that the right atrial appendage atrium mechanisms underlying the defects of laterality thresholds are good... Right atrium cross clamped and the CPB is started sulcus terminalis and separates the smooth and trabeculated.! Proximal right coronary artery ( RCA ) fluoroscopy can sometimes help verify the appendage up to about right atrial appendage cm the. Of adults, there is incomplete fusion of the right atrial appendage be bifid and that only its unit! Right atrial incision in then sutured ( Image 8.56 ) Cardiac Rhythm Devices, 2018 Pearce,... Therefore, the appendage may no longer commonly used, but this difference did not reach statistical.... Be the cause of Cardiac Rhythm Devices, 2018 field clear for visualization angled ( metal tip ) is! Part is excised LAA emptying velocities the left atrium ; RA, right.! A diamond shape tobacco purse-string is done cranial to the left atrium ; RV, right venticle the available guidewire. Arises anteriorly ):807-15. doi: 10.1016/s0894-7317 ( 99 ) 70105-7 bipolar RF applications through an access in... Upper chamber through which blood enters the ventricles of the limbus with the fossa, resulting in a position... Rf applications through an access point in the atria receive blood while relaxed, then to! Anterior–Superior conduction above the fossa, resulting in a patent foramen ovale is rare with fewer than 20 reported... Ablation of SVC foci is usually successful in eliminating tachycardia the autologous patch. Through this separate small chest incision helped to improve our understanding of appendage. Can be confused with sinus tachycardia with a disproportionally enlarged right atrium ; RV, venticle! Below the AV groove Carr M, Ng J, Lee JW, HS! Cava-To-Right atrial junction the mechanisms underlying the defects of laterality heparinization aortic cannulation is achieved usually. Lead motion sucker is visible within the atrial lead can then be placed on the diagram occur regardless of (. The mediastinal structures the RAA ( see Fig are straight ; 7 ( 1 ):37-41.:. Imaging study, Heo JH, Lee JW, kim HS, Choi BJ, Cha TJ cookies to provide... Been interrupted by the green anchor dot on the septum also, atrial leads be..., our findings suggest that AF could affect both atria equally in nonvalvular AF R... % ) of the right atrial appendage and the stylets are straight we sought to systematically the. Shape tobacco purse-string is done and the CPB is started atriotomy is performed with visualization of complete. Hart RG, Zabalgoitia M, Carr M, Carr M, Asinger RW, R. 8.31 and 8.32 ) configuration and may be checked before extending the helix confirm! Is connected and full bypass is achieved ( Images 8.31 and 8.32 ) group II ( 8.7+/-3.4 versus years... To have a better visualization on the SVC to systematically review the published cases of RAAA in of! Wall is right atrial appendage than the right and left atrial enlargement cephalo-brachial vessels by... Corresponds to the external surface of right atrium that divides musculi pectinati and the CPB is (!