The Ligament of Marshall: Far From Vestigial!
Background: The ligament of Marshall (LOM) is a vestigial fold of the left atrium that contains the remnant left cardinal vein, muscle bundles, and nerve fibers. Despite its description as an embryologic remnant, the LOM carries significant clinical importance as an important focus for atrial fibril...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-03-01
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| Series: | Annals of Thoracic Surgery Short Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772993124003620 |
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| author | Raghav Chandra, MD Jasmina Ehab, MD Madhuri Nagaraj, MD Suresh Keshavamurthy, MD |
| author_facet | Raghav Chandra, MD Jasmina Ehab, MD Madhuri Nagaraj, MD Suresh Keshavamurthy, MD |
| author_sort | Raghav Chandra, MD |
| collection | DOAJ |
| description | Background: The ligament of Marshall (LOM) is a vestigial fold of the left atrium that contains the remnant left cardinal vein, muscle bundles, and nerve fibers. Despite its description as an embryologic remnant, the LOM carries significant clinical importance as an important focus for atrial fibrillation propagation as well as a therapeutic target. Methods: In this review, we discuss the embryologic origins of the LOM, its physiology and importance in atrial fibrillation pathogenesis, as well as the role of targeting and ablating the LOM surgically during concomitant cardiac surgery including lung transplantation. Results: The LOM, particularly its distal segment, is an important focus for atrial fibrillation as both a primary trigger as well as an accessory bundle for signal propagation. It is a key target for electrophysiologic therapies including radiofrequency and alcohol-based ablative strategies. The LOM is also a crucial target for surgical ablation while addressing the left atrial lesion sets. This is often performed concomitantly with other cardiac surgical operations and may play an important role in reducing the risk of postoperative atrial fibrillation after lung transplantation. Conclusions: Far from just a vestigial structure, the ligament of Marshall remains an important focus for paroxysmal atrial fibrillation and is a potent therapeutic target for both electrophysiologic and surgical approaches. |
| format | Article |
| id | doaj-art-148b4bc0343349378280aaa697f68478 |
| institution | OA Journals |
| issn | 2772-9931 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Thoracic Surgery Short Reports |
| spelling | doaj-art-148b4bc0343349378280aaa697f684782025-08-20T02:11:12ZengElsevierAnnals of Thoracic Surgery Short Reports2772-99312025-03-013125325710.1016/j.atssr.2024.09.001The Ligament of Marshall: Far From Vestigial!Raghav Chandra, MD0Jasmina Ehab, MD1Madhuri Nagaraj, MD2Suresh Keshavamurthy, MD3Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Address correspondence to Dr Keshavamurthy, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.Background: The ligament of Marshall (LOM) is a vestigial fold of the left atrium that contains the remnant left cardinal vein, muscle bundles, and nerve fibers. Despite its description as an embryologic remnant, the LOM carries significant clinical importance as an important focus for atrial fibrillation propagation as well as a therapeutic target. Methods: In this review, we discuss the embryologic origins of the LOM, its physiology and importance in atrial fibrillation pathogenesis, as well as the role of targeting and ablating the LOM surgically during concomitant cardiac surgery including lung transplantation. Results: The LOM, particularly its distal segment, is an important focus for atrial fibrillation as both a primary trigger as well as an accessory bundle for signal propagation. It is a key target for electrophysiologic therapies including radiofrequency and alcohol-based ablative strategies. The LOM is also a crucial target for surgical ablation while addressing the left atrial lesion sets. This is often performed concomitantly with other cardiac surgical operations and may play an important role in reducing the risk of postoperative atrial fibrillation after lung transplantation. Conclusions: Far from just a vestigial structure, the ligament of Marshall remains an important focus for paroxysmal atrial fibrillation and is a potent therapeutic target for both electrophysiologic and surgical approaches.http://www.sciencedirect.com/science/article/pii/S2772993124003620 |
| spellingShingle | Raghav Chandra, MD Jasmina Ehab, MD Madhuri Nagaraj, MD Suresh Keshavamurthy, MD The Ligament of Marshall: Far From Vestigial! Annals of Thoracic Surgery Short Reports |
| title | The Ligament of Marshall: Far From Vestigial! |
| title_full | The Ligament of Marshall: Far From Vestigial! |
| title_fullStr | The Ligament of Marshall: Far From Vestigial! |
| title_full_unstemmed | The Ligament of Marshall: Far From Vestigial! |
| title_short | The Ligament of Marshall: Far From Vestigial! |
| title_sort | ligament of marshall far from vestigial |
| url | http://www.sciencedirect.com/science/article/pii/S2772993124003620 |
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