Differentiating LAA Thrombus From Spontaneous Echo Contrast for Safe LAA Occlusion

Figures

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  Visual Summary. Diagram Summarizing the Case Series CT = computed tomography; LAA = left atrial appendage, LAAO = left atrial appendage occluder, TEE = transesophageal echocardiography, SEC = spontaneous echo contrast.

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  Figure 1. Cardiac Computed Tomography Scan in Case 1 (A) Early-phase cardiac CT demonstrating a filling defect within the left atrial appendage (arrow). (B) Delayed-phase cardiac CT showing persistence of the filling defect, consistent with suspected thrombus (circle). CT = computed tomography.

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  Figure 2. Intraoperative TEE Showing SEC in the LAA Before and After Dobutamine Infusion and Contrast Injection in Case 1 (A) Dense echogenic material (SEC) in the LAA concerning for thrombus (red arrow). (B) Decreased SEC density after dobutamine infusion (white arrows). (C) Complete opacification of the LAA after injecting contrast, without any filling defect (blue arrows). (D) Successful implantation of the Watchman device (yellow arrows). LAA = left atrial appendage; SEC = spontaneous echo contrast; TEE = transesophageal echocardiography.

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  Figure 3. Cardiac Computed Tomography Scan in Case 2 (A) Early-phase cardiac CT demonstrating a filling defect within the left atrial appendage (arrow). (B) Delayed-phase cardiac CT showing persistence of the filling defect, consistent with suspected thrombus (circle). CT = computed tomography.

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  Figure 4. Intraoperative TEE Showing SEC in the LAA Before and After Dopamine Infusion in Case 2 (A and B) Dense echogenic material (SEC) in the LAA concerning for thrombus (red arrows). (C) Complete resolution of SEC after dopamine infusion (blue arrows). (D) Successful implantation of Watchman device (yellow arrow). LAA = left atrial appendage; SEC = spontaneous echo contrast; TEE = transesophageal echocardiography.

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  Figure 5. Intraoperative TEE Showing SEC in the LAA Before and After Definity Contrast Injection in Case 3 (A) Dense echogenic material in the LAA concerning for thrombus (red arrows). (B) Complete opacification of the LAA after injecting contrast, without any filling defect (blue arrows). (C) Successful implantation of the Watchman device (yellow arrows). LAA = left atrial appendage; SEC = spontaneous echo contrast; TEE = transesophageal echocardiography.

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  Figure 6. Proposed Diagnostic Algorithm to Differentiate Left Atrial Appendage Thrombus From Spontaneous Echo Contrast Before Left Atrial Appendage Occlusion LAA = left atrial appendage; LAAO = left atrial appendage occlusion; SEC = spontaneous echo contrast; TEE = transesophageal echocardiography.