Measurement of left atrial appendage size by transesophageal echocardiography

Abstract

Transesophageal echocardiography (TEE) is the most common imaging method for evaluating left atrial morphology. Recent advances in 64-slice multidetector computed tomography (64-MDCT) allow accurate measurement of left atrial appendage (LAA) volume. The aim of this study was to evaluate the accuracy of LAA sizing by TEE in comparison with 64-MDCT in patients with atrial fibrillation. Electrocardiogram-gated 64-MDCT and TEE were performed within 2 days in 18 consecutive patients (63 ± 9 years old, 12 males, 5 paroxysmal atrial fibrillation) with nonvalvular atrial fibrillation. LAA area and LAA volume were measured at end-systole by TEE and 64-MDCT, respectively. The largest LAA area was measured on TEE image. Five patients were in sinus rhythm during examinations. In all patients, LAA was clearly visualized; the largest area of LAA was 9.3 ± 3.9 mm(2) and the LAA volume was 21.6 ± 7.5 ml. A significant correlation between LAA area and LAA volume was observed (p = 0.0003, r = 0.75). TEE allows a detailed evaluation of the LAA structure by two-dimensional imaging. LAA size could be evaluated by TEE despite its morphological complexity, i.e., sac-like or multilobed structure.

Safety and feasibility of left atrial appendage inversion in swine: A proof-of-concept study for potential therapy to prevent embolic stroke

“…TEE is the gold standard technology for LAA geometry in patients. Orifice diameter, depth, and area are valid indicators ( Yoshimoto et al, 2012 ; Bai et al, 2017 ; Freixa et al, 2020 ) to measure the size of LAA before the device implant and to evaluate residual flow around implanted device after occlusion. After LAA inversion, these parameters were significantly lowered.…”

“…TEE was done in a two-chamber longitudinal view for LAA visualization ( Yoshimoto et al, 2012 ). The images were analyzed by ShowCase software (Trillium Technologies).…”

“…The images were analyzed by ShowCase software (Trillium Technologies). The orifice diameter, depth, and maximum area of the LAA were measured as previously reported ( Yoshimoto et al, 2012 ; Bai et al, 2017 ; Sarić, 2017 ). ICE was performed following an established protocol ( Baran et al, 2013 ; Berti et al, 2021 ).…”

Left atrial appendage thrombus detected by transesophageal examination with linear endoscopic ultrasound

“…Transthoracic echocardiography does not usually afford detailed views of the LAA because it is posteriorly located . On the other hand, transesophageal echocardiography (TEE) provides highly accurate images of the LAA and is considered to be a valuable tool for diagnosing LAA thrombi . In this report, we provide images of an LAA thrombus detected by transesophageal observation with L‐EUS and highlight a new potential role for L‐EUS.…”