Real-time three-dimensional transoesophageal echocardiography for diagnosis of left atrial appendage thrombus

Laţcu, Decebal Gabriel; Rinaldi, J.-P.; Saoudi, Nadir

doi:10.1093/ejechocard/jep076

Cited by 18 publications

(13 citation statements)

References 5 publications

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“…Not only the above mentioned en-face view; even the transverse Xplane (2 perpendicular planes screened simultaneously) can help. This has also been documented in other published case reports and small studies [3][4][5] . A typical picture of musculi pectinati seen in 2DE and 3DE is seen in (Fig.…”

Section: Discussionsupporting

confidence: 81%

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Real time 3-dimensional transesophageal echocardiography is more specific than 2-dimensional TEE in the assessment of left atrial appendage thrombosis

Marek¹,

Vindiš²,

Kociánová³

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. In patients indicated for detection of intraatrial thrombus (T), 2-dimensional transesophageal echocardiography (2DTEE) is routinely used but differentiation between T and trabeculae or artifacts in the left atrial appendage (LAA) is often difficult. Aims. To compare the diagnostic value of real time 3D-transesophageal echocardiography (RT3DTEE) and 2DTEE in the assessment of LAA thrombosis. Patients and Methods. One hundred and ten consecutive patients (73M, aged 64+-13) were examined by 2DTEE. In terms of possible T, individual pts were diagnosed as negative (N2), uncertain trabecular finding (U2), other/artifacts (O2), and clearly positive (T2). The RT3DTEE was then applied and the categorization repeated (N3,U3,O3 and T3, resp.). Finally, the operator decided whether the RT3DTEE. A: had an additional diagnostic value, and/or B: changed the definite diagnosis of thrombosis. Results. N2:71; U2:17; O2:19; T2:3; N3:97; U3:1; O3:12; T3:0. Ad A/ RT3DTEE enabled us to refine or change the diagnosis in 26/110 cases. 17 pts were switched from group U2 to N3, 7:O2-N3 and 2:T2-N3. 12 pts from O2 and 1 pt from T2 remained unclarified. Ad B/ Diagnoses were changed in 6 patients after RT3DTEE. A very suspicious T2 was found in 3 patients. In 1, the finding was requalified definitely as musculi pectinati. In the second patient, the finding was recategorized as just a spontaneous echocontrast without T. In another 4 patients, T in LAA was definitely excluded after RT3DTEE (1 patient switched from U2 to N3, 3 from O2 to N3). In another 13, the findings remained unclear, mostly because of poor quality image. No real thrombus was found in this study. Conclusion. RT3DTEE provides additional information, which may be helpful in the differentiation of thrombus from other findings. It is particularly useful in the identification of muscular trabeculae in the left atrial appendage.

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Section: Discussionsupporting

confidence: 81%

“…Only a few minor studies have been published on this topic, mainly in the form of case reports [3][4][5] . A typical LAA thrombus on RT3DTEE is seen in (Fig.…”

Section: Introductionmentioning

confidence: 99%

Real time 3-dimensional transesophageal echocardiography is more specific than 2-dimensional TEE in the assessment of left atrial appendage thrombosis

Marek¹,

Vindiš²,

Kociánová³

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…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. Latcu et al 16 showed that RT3D TEE could differentiate pectinate muscles from thrombi in a patient with atrial fibrillation scheduled for catheter ablation. Our observations are consistent with these reports and extend their findings to the clinical scenario of TEE-guided cardioversion of atrial fibrillation.…”

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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“…Latcu et al [10] demonstrated that the pectinate muscle arrangement in LAA was clearly observable by this new technique. We suspect that three-dimensional transesophageal echocardiography may be a useful tool for evaluating LA morphology, but advances in image quality and frame number are still required.…”

Section: Discussionmentioning

confidence: 88%

Measurement of left atrial appendage size by transesophageal echocardiography

Yoshimoto

Mizushige

et al. 2011

J Med Ultrasonics

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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.

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Real-time three-dimensional transoesophageal echocardiography for diagnosis of left atrial appendage thrombus

Abstract: We report a case where real-time 3D TEE proved the non-thrombotic nature of a particular pectinated muscle arrangement within the LAA.

Cited by 18 publications

References 5 publications

Real time 3-dimensional transesophageal echocardiography is more specific than 2-dimensional TEE in the assessment of left atrial appendage thrombosis

Real time 3-dimensional transesophageal echocardiography is more specific than 2-dimensional TEE in the assessment of left atrial appendage thrombosis

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

Measurement of left atrial appendage size by transesophageal echocardiography

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