Absent left atrial appendage in a patient with mitral stenosis

A 50-year-old woman, diagnosed with severe rheumatic mitral stenosis, was referred for transesophageal echocardiography (TEE) study to confirm suitability for percutaneous balloon valvotomy and to look for evidence of thrombus in the left atrial appendage (LAA). TEE evaluation followed by computed tomography scan and magnetic resonance imaging confirmed congenital absence of LAA - a rare occurrence with fewer than 25 reports in the literature.

To evaluate the diagnostic process and clinical implications of absent left atrial appendage in the context of severe rheumatic mitral stenosis, emphasizing the utility of transesophageal echocardiography, contrast-enhanced computed tomography scan, and cardiac magnetic resonance imaging in identifying this rare anomaly with its impact on therapeutic decision-making.