Related Experiment Video
Updated: Sep 17, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Usefulness of Echocardiography Contrast Agents for the Detection of Residual Leak After Percutaneous LAA Closure
Abdellaziz Dahou1, Nathanael Tran1, Jacob Dal-Bianco1
1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Echo contrast agents effectively detect residual leaks after left atrial appendage closure (LAAC) when standard methods are inconclusive. This low-cost tool aids in diagnosing leaks, improving patient management after LAAC procedures.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Percutaneous left atrial appendage closure (LAAC) is a common procedure for stroke prevention in atrial fibrillation.
- Residual leaks post-LAAC increase thromboembolic event risk, necessitating accurate detection.
- Cardiac computed tomography (CCT) and transesophageal echocardiography (TEE) are used for follow-up, but diagnosis can be challenging.
Observation:
- A 78-year-old woman with atrial fibrillation and prior transient ischemic attack underwent successful LAAC with a WATCHMAN device.
- Initial TEE showed no residual leak; anticoagulation was discontinued.
- Subsequent TEE revealed an abnormal gap around the device, with color Doppler suggesting a leak, but diagnosis remained uncertain.
Findings:
- Contrast-enhanced TEE definitively diagnosed a residual leak after LAAC.
- The echo contrast agent provided clear visualization, aiding in management decisions.
- This case highlights the utility of contrast agents in challenging TEE evaluations for LAAC leaks.
Implications:
- Echo contrast agents offer a valuable, low-cost alternative to CCT for detecting residual LAAC leaks.
- This technique can improve diagnostic accuracy in cases where color Doppler is inconclusive.
- Wider adoption of contrast-enhanced TEE could enhance post-LAAC monitoring and patient outcomes.
Background:
Residual leaks after percutaneous left atrial appendage closure (LAAC) are associated with an increase in thromboembolic events. Therefore, their detection and correction are crucial.
Case Summary:
This case was a 78-year-old woman with history of long-standing atrial fibrillation complicated by transient ischemic attack who underwent a percutaneous LAAC with a WATCHMAN device, with no residual leak. Initial follow-up transesophageal echocardiography (TEE) was unremarkable and anticoagulation therapy was stopped. Subsequent TEE was performed due to abnormal gap around the device noted on cardiac computed tomography. TEE findings were concerning for residual leak by color Doppler, but a definite diagnosis could not be made. An echo contrast agent was then used, which helped establish a definite diagnosis of residual leak and helped guide further management.
Discussion:
This is the first case to show the usefulness of echo contrast agents to detect residual leaks after LAAC.
Take-Home Message:
The use of contrast agents during TEE represents a low-cost and readily available tool that may become an alternative to cardiac computed tomography for the detection of residual leaks after LAAC in challenging cases, when color Doppler is inconclusive.
Related Concept Videos
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...