Real-Time Three-Dimensional Transesophageal Echocardiography of the Left Atrial Appendage: Initial Experience in the Clinical Setting

Shah, Sanjiv J.; Bardo, Dianna M. E.; Sugeng, Lissa; Weinert, Lynn; Lodato, Joseph A.; Knight, Bradley P.; López, John J.; Lang, Roberto M.

doi:10.1016/j.echo.2008.09.024

Cited by 98 publications

(60 citation statements)

References 25 publications

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“…The size of the LAA can be accurately measured with RT3D TEE, and the LAA orifice area by RT3D TEE correlates more closely with computed tomographic measurements than 2D TEE measurements. 4 Mizuguchi et al 14 described the diagnosis of a bilobed LAA with RT3D TEE as an incidental finding during preoperative TEE in a patient undergoing open heart surgery. Cummisford et al 15 reported the definitive diagnosis of a bilobed LAA by RT3D TEE, which allowed the surgeons to proceed with a thorascopic maze procedure and LAA ligation after preoperative 2D TEE yielded inconclusive results because of suspicion of an LAA thrombus.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…2,3 The LAA can be comprehensively evaluated by real-time 3-dimensional (RT3D) TEE. 4 We report 3 patients with atrial fibrillation or flutter and accessory lobes or pectinate muscles mimicking thrombi in whom the additional images provided by RT3D TEE were decisive in making the correct diagnosis and excluding contraindications to cardioversion.…”

mentioning

confidence: 98%

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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“…Accurate real-time quantification of the LA appendage, which is essential to ensure correct sizing and placement of occluder devices, has been achieved by 3D MTEE imaging ( Figure 13E). 115 The role of 3D MTEE for the guidance of catheter placement during electrophysiology procedures ( Figure 13,F) remains to be established. In the future, developments in intracardiac 3D ultrasound may address the challenges of acquiring high-quality 3D visualization of the left atrium and pulmonic veins.…”

Section: Rt3de Guidance and Evaluation Of Intracardiac Interventionsmentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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O ne of the most significant developments of the last decade in ultrasound imaging of the heart was the evolution of 3-dimensional (3D) imaging from slow and labor-intense offline reconstruction to real-time volumetric imaging. This imaging modality provides valuable clinical information that empowers echocardiographers with new levels of confidence in the diagnosis of heart disease. We have previously described the technological milestones in the development of real-time 3D echocardiographic (RT3DE) imaging and its major advantages over conventional 2-dimensional echocardiography (2DE) and reviewed the published literature that supported the use of this new methodology in clinical practice. 1 Since 2006, the growing availability of RT3DE technology, its ease of use, and its multiple attractive features have sparked significant interest in the research community, resulting in a large number of publications, most of which have endorsed RT3DE imaging for clinical use by demonstrating its unique capabilities in different scenarios. In parallel, the clinical acceptance of this new tool has broadened significantly. The most recent clinically significant addition is matrix-array transesophageal echocardiography (TEE), which provides images of unprecedented quality that aid surgeons and interventional cardiologists in planning and guiding procedures and evaluating their outcomes.The purpose of the present article is to review the most recent RT3DE literature and provide readers with an update on the latest developments and the current status of this noninvasive imaging tool. Because different potential applications of RT3DE imaging have been explored to various extents, they are described here separately, and each is discussed with an emphasis on the scientifically established facts, along with the known stumbling blocks and difficulties. Quantification of LV Volumes and FunctionA firmly established advantage of 3D imaging over crosssectional slices of the heart is the improvement in the accuracy of the evaluation of left ventricular (LV) volumes and ejection fraction (EF) by eliminating the need for geometric modeling, which is inaccurate in the presence of aneurysms, asymmetrical ventricles, or wall motion abnormalities, and the errors caused by foreshortened views even in symmetrical ventricles. The value of RT3DE imaging in this context has been demonstrated by multiple studies that compared RT3DE volume measurements with widely accepted reference techniques, including radionuclide ventriculography and cardiac magnetic resonance (CMR). [2][3][4][5][6] These studies and others have demonstrated higher levels of agreement between the RT3DE approach and the respective reference technique compared with conventional 2DE methodology. Additionally, RT3DE measurements were found to be more reproducible than 2DE 4,5,7 and, in some studies, even as reproducible as CMR. 8 Interestingly, in a recent study in patients after myocardial infarction (MI), 9 RT3DE-derived LV volumes were more accurate and more reproducible than thos...

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“…Although CT and MRI have been used to assess LAA morphology, [6][7][8] initial studies with three-dimensional (3D) transesophageal echocardiography (TEE) have also shown the potential to assess LAA morphology. 9,10 Recently, our coworkers reported that 3D-TEE could evaluate the LAA volume, orifice area, depth, and number of LAA lobes from reconstructed 3D LAA images. 11 Therefore, the aim of our study was to clarify the relation between LAA morphology evaluated with 3D-TEE and LAA thrombus in patients with AF in comparison with conventional indices.…”

mentioning

confidence: 99%

Complex Left Atrial Appendage Morphology and Left Atrial Appendage Thrombus Formation in Patients With Atrial Fibrillation

Yamamoto

Seo

Kawamatsu

et al. 2014

Circ: Cardiovascular Imaging

159

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Background-In patients with atrial fibrillation (AF), most thrombus forms in the left atrial appendage (LAA). However, the relation of LAA morphology with LAA thrombus is unknown. Methods and Results-We prospectively enrolled 633 consecutive patients who were candidates for catheter ablation for symptomatic drug-resistant AF. Transesophageal echocardiography (TEE) was performed to assess LAA thrombus. LAA structure was assessed by 3-dimensional TEE. LAA orifice area, depth, volume, and number of lobes were measured on reconstructed 3-dimensional images. Clinical characteristics and echocardiographic measures were compared to determine variables predicting LAA thrombus.

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Real-Time Three-Dimensional Transesophageal Echocardiography of the Left Atrial Appendage: Initial Experience in the Clinical Setting

Cited by 98 publications

References 25 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

Real-Time 3-Dimensional Echocardiography

Complex Left Atrial Appendage Morphology and Left Atrial Appendage Thrombus Formation in Patients With Atrial Fibrillation

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