Threading the Needle: Left Atrial Ridge Mass Complicating Percutaneous Left Atrial Appendage Occlusion

Figures

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  Figure 1. Case 1. Two-dimensional TEE, mid-esophageal long-axis (39°) diastolic (left) and systolic (right) view, demonstrates a 0.6 cm × 0.1 cm independently mobile elongated mass arising from the LAR. The arrow shows the LAR mass. LA, Left atrium; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 2. Case 1. Three-dimensional TEE, mid-esophageal long-axis (85°) diastolic (left) and systolic (right) view with photorealistic rendering, demonstrates an independently mobile elongated mass arising from the LAR. The arrow shows the LAR mass. LA, Left atrium; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 3. Case 1. Two-dimensional TEE, mid-esophageal long-axis (89°) diastolic (left) and systolic (right) view, demonstrates the LAAO device attached to the delivery system and in place with visualization of the independently mobile LAR mass. The arrow shows the LAR mass. LA, Left atrium; LAAO, LAAO device; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 4. Case 1. Timeline figure demonstrates TEE images of the LAR with attached mass before, during, and after LAAO. The arrow shows the LAR mass. LA, Left atrium; LAAO, LAAO device; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 5. Case 2. Two-dimensional TEE, mid-esophageal long-axis (45°) diastolic (left) and systolic (right) view, demonstrates a dilated LA and LAA anatomy amenable to percutaneous closure. LA, Left atrium.

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  Figure 6. Case 2. Two-dimensional TEE, mid-esophageal long-axis (89°) diastolic (left) and systolic (right) view with color-flow Doppler, demonstrates the LAAO device in place with a 4 mm PDL (arrow). LA, Left atrium; LAAO, LAAO device.

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  Figure 7. Case 2. Two-dimensional TEE, mid-esophageal long-axis (40°) diastolic (left) and systolic (right) view, demonstrates the LAAO device in place and an independently mobile, 0.3 cm × 0.1 cm elongated mass arising from the LAR. The arrow shows the LAR mass. LA, Left atrium; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 8. Case 2. Three-dimensional TEE, mid-esophageal long-axis (en face; 40°) diastolic (left) and systolic (right) view with photorealistic volume-rendering, demonstrates the independently mobile, elongated mass arising from the LAR. The arrow shows the LAR mass. LA, Left atrium; LAR, left atrial ridge; LUPV, left upper pulmonary vein.

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  Figure 9. Case 2. Timeline figure demonstrates TEE images of the LAR with attached mass during, 1.5 months following, and 7 months following LAAO. The yellow arrow shows the LAR mass; the red arrow shows the PDL. LA, Left atrium; LAAO, LAAO device; LAR, left atrial ridge; LUPV, left upper pulmonary vein.