Surgical closure of LAA during mitral valve surgery

Surgical closure of LAA during mitral valve surgery

Transesophageal intra-operative diagnosis of left atrial appendage thrombus

February 28, 2022
Pages: 1

Topics:

  • Transesophageal echocardiography
  • Intraoperative
  • Left atrial appendage
  • Thrombus
Figure 1. 2D, upper esophagus, long axis (80 deg)

Pre-CPB (cardiopulmonary bypass) TE exam.

Figures 1-3. 69 year old female (BSA= 1.4 m2) with rheumatic heart disease and severe mitral valve stenosis (MS). In the image (Image 1) -upper esophageal long axis view (80 deg) of the left atrium (LA) and left atrial appendage (LAA) – there is the doubt of a dense stratified thrombus in the LAA apex. There is dense spontaneous echo-contrast in both the LA and LAA cavities.

Figure 2. 2D, upper esophagus, intermediate short-long axis (32 deg)
Figure 3. 2D, upper esophagus, long axis (102 deg)

Figures 2 and 3. Appropriate scanning using multiple short and long axis view angles with simultaneous gentle probe torsion (very important) excludes the presence of LAA thrombus.

Figure 4. 3D, upper esophagus, surgeon’s view of LA and LAA
Figure 5. 3D, upper esophagus, surgeon’s view of LAA

Figures 4 and 5. 3D rendering of the LA lateral and anterior walls – including the LAA – (Image 4) and progressive scanning of the LAA by “cutting” through the LAA cavity (Image 5) help in excluding the presence of an LAA thrombus.

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