Transnasal Transesophageal Echocardiography Guidance for Percutaneous Left Atrial Appendage Closure

In the local anesthesia state, left atrial appendage closure cannot be accomplished under the real-time guidance of conventional transesophageal echocardiography because it induces significant discomfort for the patient. Transnasal transesophageal echocardiography can be well-tolerated by patients without general anesthesia for a prolonged examination time and can acquire excellent images. This case report describes the initially successful percutaneous left atrial appendage closure under the real-time guidance of transnasal transesophageal echocardiography without general anesthesia in a nonvalvular atrial fibrillation patient. The device covered the ostium of the left atrial appendage properly and stably, and there was no significant residual peridevice leak or device-associated thrombus postoperatively.