Comparative Assessment of Left Atrial Appendage by Transesophageal and Combined Two‐ and Three‐Dimensional Transthoracic Echocardiography<sup>‡</sup>

Karakuş, Gültekin; Kodali, Visali; Inamdar, Vatsal; Nanda, Navin C.; Suwanjutah, Thouantosaporn; Pothineni, Koteswara R.

doi:10.1111/j.1540-8175.2008.00758.x

Cited by 53 publications

(28 citation statements)

References 12 publications

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“…Three-dimensional transthoracic echocardiography has shown promise as an imaging modality to assess the LAA. Karakus et al 8 showed that 3D transthoracic echocardiography could detect thrombi and distinguish pectinate muscle from thrombi. However, the image quality of 3D transthoracic echocardiography is generally inferior to that of RT3D TEE, especially for posterior structures such as the LAA, and the broad application of 3D transthoracic echocardiography for assessing thrombi in the LAA may not be feasible.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Willens

Qin

Keith

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Transesophageal echocardiography (TEE)-guided cardioversion is an established strategy for managing atrial arrhythmias and is commonly used as an alternative to the conventional approach of administering several weeks of anticoagulation before cardioversion. However, the safety of this approach depends on the exclusion of left atrial appendage (LAA) thrombi with a high level of diagnostic confidence. The objective of this case series is to explore the use of real-time 3-dimensional (RT3D) TEE in the precardioversion evaluation of patients with complex anatomy in their LAAs. Methods. We used RT3D TEE to further assess the LAAs of 3 patients being evaluated for cardioversion who had inconclusive 2-dimensional (2D) TEE studies because of complex anatomic variants of the LAA. We imaged the LAA using the 3D zoom mode and rotated this image to view the LAA en face from the perspective of its ostium. Further cropping was performed as needed. Results. In all 3 patients, the additional views of the appendage obtained by RT3D TEE were decisive in excluding contraindications to cardioversion. The unique en face view of the LAA acquired with 3D TEE, which was previously unobtainable using 2D TEE, was particularly useful. In 1 patient, a bilobed LAA mimicked a thrombus. In 2 other patients, prominent pectinate muscles masqueraded as thrombi. Conclusions. Three-dimensional TEE is valuable for the precardioversion evaluation of patients with complex anatomic variants of the LAA.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Willens

Qin

Keith

et al. 2010

Journal of Ultrasound in Medicine

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“…4,5 Because of the close proximity of the transducer to the left ventricular apex, TTE is generally considered to be superior to TEE for thrombus detection. However, TEE has been shown to be a useful complementary approach because of the lack of reflection artifacts and no near-field resolution limitations.…”

Section: Discussionmentioning

confidence: 99%

Detection of Left Ventricular Apical Thrombus With Three-Dimensional Transesophageal Echocardiography

Puskás

Cleveland

Singh

et al. 2011

Semin Cardiothorac Vasc Anesth

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OBJECTIVE. Left ventricular (LV) thrombosis persists as a clinical challenge in echocardiographic diagnosis and is an important risk factor for perioperative embolic events in cardiac surgery. Appropriate detection and monitoring when thrombus is suspected is critical in surgical planning and in avoiding catastrophic patient outcomes. CASE PRESENTATION. The authors present a case of a laminated LV apical thrombus, which was discovered intraoperatively by real-time 3-dimensional (3D) transesophageal echocardiography. CLINICAL CHALLENGES. The clinical challenges were (a) LV thrombosis impact on surgical management, (b) key echocardiographic challenges in diagnosing LV thrombosis, and (c) role of 3D echocardiography in the diagnostic algorithm. CONCLUSION. Because of the lack of a gold standard, 2D transthoracic echocardiography remains the imaging modality of choice in assessment; however, there is increasing evidence that 3D technology can be more accurate in intracardiac mass detection and should be considered in the diagnostic algorithm.

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“…In general, TTE is inferior to TEE in the evaluation of LAA morphology and function [19,27,47]. Poor LAA visualisation in more than 20% patients, inability to identify dysfunction, SEC and blood clots are still major obstacles for use of TTE.…”

Section: Transthoracic Echocardiographymentioning

confidence: 99%

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

Lohvinov

Mikhaliev²,

Zharinov

2015

Kardiol Pol

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Comparative Assessment of Left Atrial Appendage by Transesophageal and Combined Two‐ and Three‐Dimensional Transthoracic Echocardiography^‡

Abstract: Our preliminary study suggests that combined 2DTTE and 3DTTE has comparable accuracy to TEE in evaluating the LA and LAA for thrombus. In some patients TEE, but not 3DTTE, may misdiagnose pectinate musculature as thrombus.

Cited by 53 publications

References 12 publications

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Detection of Left Ventricular Apical Thrombus With Three-Dimensional Transesophageal Echocardiography

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

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Comparative Assessment of Left Atrial Appendage by Transesophageal and Combined Two‐ and Three‐Dimensional Transthoracic Echocardiography‡

Abstract: Our preliminary study suggests that combined 2DTTE and 3DTTE has comparable accuracy to TEE in evaluating the LA and LAA for thrombus. In some patients TEE, but not 3DTTE, may misdiagnose pectinate musculature as thrombus.

Cited by 53 publications

References 12 publications

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Detection of Left Ventricular Apical Thrombus With Three-Dimensional Transesophageal Echocardiography

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

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Comparative Assessment of Left Atrial Appendage by Transesophageal and Combined Two‐ and Three‐Dimensional Transthoracic Echocardiography^‡