Case report. Thrombus formation on left atrial appendage clip: surgical exclusion and anticoagulation do not obviate transesophageal echocardiography prior to cardioversion

Figures

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  Figure 1. Preoperative and precardioversion transesophageal echocardiograms of Patient #1. (A) Preoperative transesophageal echocardiogram, mid esophageal left atrial appendage focused view at 128°, demonstrating absence of thrombus. (B) Precardioversion transesophageal echocardiogram after surgical left atrial appendage exclusion with Atriclip device, mid esophageal left atrial appendage biplane at 120° (left) and 210° (right) with colour Doppler interrogation at low velocities (15.4 cm/s) demonstrating lack of flow in the corresponding area of thrombus (arrow).

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  Figure 2. Preoperative and pre cardioversion transesophageal echocardiograms of Patient #2. (A) Preoperative transesophageal echocardiogram, mid esophageal left atrial appendage focused view at 127° demonstrating absence of thrombus and ‘chicken wing’ morphology. (B) Precardioversion transesophageal echocardiogram after surgical left atrial appendage exclusion with Atriclip device, mid esophageal biplane view of the left atrial appendage at 90° (left) and 12° (right), demonstrating the presence of a soft thrombus in the left atrial appendage stump (asterisk).

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  Figure 3. AtriClip implantation technique. (A) Utilization of the Gillinov–Cosgrove selection guide to determine correct selection of the clip size. (B) Approximation of the device and positioning at the base of the appendage. (C) Deployment of the clip and removal of the effector, leaving the clip in place.

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