Surgical closure of LAA during mitral valve surgery
Transesophageal intra-operative diagnosis of left atrial appendage thrombus
February 28, 2022
- Transesophageal echocardiography
- Left atrial appendage
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.
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.
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.