SEE PAGE 135 T he development and increasing use of percutaneous left atrial appendage closure (LAAC) to reduce thromboembolic risk associated with atrial fibrillation has stimulated renewed interest in the broader role of the LAA in normal cardiovascular physiology and response to stress. The heart is a neuroendocrine organ, and the alteration or elimination of a viable LAA may have potentially deleterious effects. The LAA is a source of A-type or atrial natriuretic peptide (ANP) and B-type or brain natriuretic peptide (BNP) that typically promote diuresis, natriuresis, and vasodilation in response to stretch and other stimuli (1-3). Predominantly, ANP is secreted by myocytes throughout the atria, with the appendages accounting for 30% of cardiac sources (4), although storage granules are more dense in the right than the left appendage (5). The predominant source of BNP is ventricular, although the atria seem to contribute more in heart failure and atrial fibrillation. The LAA is richly innervated by both parasympathetic and sympathetic fibers, although not as densely as the LA posterior wall or pulmonary veins (6-8). Both atrial appendages participate in reflex responses to stretch, although removal of the right or both appendages seems to have a greater impact than LAA removal alone (4,9). The precise neural pathways involved are not well-established. Approaches to percutaneous LAAC differ in their impact on the survival of appendage tissue. Epicardial closure techniques by suture snare at the ostium (Lariat, SentreHEART, Palo Alto, California) leads to

中文翻译：

---

神经激素调节和左心耳

参见第 135 页 经皮左心耳封堵术 (LAAC) 的发展和越来越多地使用以降低与心房颤动相关的血栓栓塞风险，激发了人们对 LAA 在正常心血管生理学和应激反应中更广泛作用的兴趣。心脏是神经内分泌器官，活性左心耳的改变或消除可能具有潜在的有害影响。LAA 是 A 型或心房利钠肽 (ANP) 和 B 型或脑利钠肽 (BNP) 的来源，它们通常会促进利尿、利钠和血管舒张，以应对拉伸和其他刺激 (1-3)。ANP 主要由整个心房的肌细胞分泌，附件占心脏来源的 30% (4)，尽管右侧的储存颗粒比左侧的附件更密集 (5)。BNP 的主要来源是心室，尽管心房似乎对心力衰竭和心房颤动的贡献更大。左心耳受副交感神经和交感神经纤维的丰富支配，但不如左心耳后壁或肺静脉密集 (6-8)。两个心耳都参与对牵张的反射反应，尽管去除右心耳或两个心耳似乎比单独去除左心耳有更大的影响 (4,9)。所涉及的精确神经通路尚未确定。经皮 LAAC 的方法在对附属组织存活的影响方面有所不同。在心口缝合圈套器的心外膜闭合技术（Lariat，SentreHEART，Palo Alto，California）导致 左心耳受副交感神经和交感神经纤维的丰富支配，但不如左心耳后壁或肺静脉密集 (6-8)。两个心耳都参与对牵张的反射反应，尽管去除右心耳或两个心耳似乎比单独去除左心耳有更大的影响 (4,9)。所涉及的精确神经通路尚未确定。经皮 LAAC 的方法在对附属组织存活的影响方面有所不同。在心口缝合圈套器的心外膜闭合技术（Lariat，SentreHEART，Palo Alto，California）导致 左心耳受副交感神经和交感神经纤维的丰富支配，但不如左心耳后壁或肺静脉密集 (6-8)。两个心耳都参与对牵张的反射反应，尽管去除右心耳或两个心耳似乎比单独去除左心耳有更大的影响 (4,9)。所涉及的精确神经通路尚未确定。经皮 LAAC 的方法在对附属组织存活的影响方面有所不同。在心口缝合圈套器的心外膜闭合技术（Lariat，SentreHEART，Palo Alto，California）导致 尽管去除右侧或两个附件似乎比单独去除 LAA 具有更大的影响 (4,9)。所涉及的精确神经通路尚未确定。经皮 LAAC 的方法在对附属组织存活的影响方面有所不同。在心口缝合圈套器的心外膜闭合技术（Lariat，SentreHEART，Palo Alto，California）导致 尽管去除右侧或两个附件似乎比单独去除 LAA 具有更大的影响 (4,9)。所涉及的精确神经通路尚未确定。经皮 LAAC 的方法在对附属组织存活的影响方面有所不同。在心口缝合圈套器的心外膜闭合技术（Lariat，SentreHEART，Palo Alto，California）导致