Sara López Palanca1, Eva Mateo Rodríguez2, Paula Carmona García3
Sara López Palanca, Finding of left atrial appendage thrombus despite a normal preoperative transthoracic echocardiography. Importance of intraoperative TEE. Case report(2016)SDRP Journal Of Anesthesia & Surgery 1(2)
We report the case of a 60-year-old woman with atrial fibrillation, scheduled for aortic and mitral replacement. The intraoperative TEE revealed a new pedunculated mass in LAA protruding to LA. Preoperative TTE had been performed 2 months before, showing any mass inside.
Routine screening of the LAA for thrombi in these patients has not been investigated systematically, but screening also may be beneficial in patients with mitral valve disease, and in patients with LV dysfunction, as an LAA thrombus may be present in the absence of AF. According to the latest guidelines, TEE should be used in all open heart procedures in order to: confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anesthetic and surgical plan accordingly, and assess the results of surgical intervention.
Therefore, a thorough understanding of the LAA’s echocardiographic evaluation and the consequences of its removal are essential for the anesthesiologist.
Assessment of LAA Function by Transesophageal Echocardiography. Implications for the Development of Thrombus. Charles Pollick et al. Circulation 1991;84:223-231. PMid:2060098View Article PubMed/NCBI
Practice Guidelines for Perioperative Transesophageal Echocardiography. Anesthesiology 2010; 112:1084-96 PMid:20418689
Left atrial appendage occlusion. Alli O. et al. Heart 2015;101:834-841.
Left Atrial Appendage, Intraoperative Echocardiography, and the Anesthesiologist. Khurram Owais, Feroze Mahmood, Mario Montealegre-Gallegos, Kamal R. Khabbaz, and Robina Matyal. Journal of Cardiothoracic and Vascular Anesthesia, Vol 29, No 6 (December), 2015: pp 1651?1662. PMid:26321120View Article PubMed/NCBI