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Left atrial appendage closure: beyond the artifact.

Gianpiero D'Amico1, Marco Mojoli, Paolo Buja

  • 1aDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy *Gianpiero D'Amico and Marco Mojoli contributed equally to the writing of this article.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 4, 2014
PubMed
Summary

Transesophageal echocardiography (TEE) can misdiagnose left atrial appendage (LAA) thrombus. A case highlights reverberations from a pulmonary vein ridge mimicking LAA thrombus, crucial for percutaneous closure decisions.

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Transesophageal echocardiography (TEE) is the standard for detecting left atrial appendage (LAA) thrombus.
  • Accurate LAA thrombus identification is critical for procedures like percutaneous left atrial appendage closure.
  • Artifacts can mimic thrombi, potentially leading to misdiagnosis.

Observation:

  • A 78-year-old patient with atrial fibrillation and anticoagulation contraindication underwent evaluation for LAA closure.
  • Intraoperative TEE showed an image suggestive of LAA thrombus.
  • The suspicious image was located at twice the distance of the left upper pulmonary vein ridge from the transducer.

Findings:

  • The observed thrombus-mimicking image was identified as an artifact.
  • This artifact was caused by reverberations from the left upper pulmonary vein ridge.
  • The artifact's location and characteristics differentiated it from true LAA thrombus.

Implications:

  • TEE requires careful interpretation to distinguish true thrombi from artifacts.
  • Understanding artifact patterns, like pulmonary vein ridge reverberations, improves diagnostic accuracy.
  • Accurate imaging is vital for guiding safe and effective percutaneous left atrial appendage closure procedures.