Key result
TEE falsely suggests LAA thrombus disproven by direct surgical inspection during mitral valve replacement.
Case Report (n=1)
No
This case highlights the potential for false-positive diagnosis of left atrial appendage thrombus by TEE due to artifacts or anatomical structures, emphasizing the value of adjunct imaging techniques.
Supports caution interpreting TEE for LAA thrombus in mitral valve surgery; leaves open validation of adjunct imaging in larger cohorts.
A 47-year-old female with severe mitral stenosis underwent open mitral valve replacement. Preoperative and intraoperative transesophageal echocardiography (TEE) suggested a left atrial appendage thrombus, but no thrombus was found when the atrium was opened. While TEE is the gold standard for left atrial appendage thrombus diagnosis, its accuracy can be affected by artifacts, as well as normal anatomical structures, such as the coumadin ridge or pectinate muscle trabeculations, which may mimic thrombus, and by spontaneous echogenic contrast. Adjunct imaging techniques, including 3D TEE, left atrial appendage outflow velocity, and contrast-enhanced imaging, can improve accuracy. Cardiac CT is also a valuable alternative. In this case, the mass may have resulted from blood stasis rather than a true thrombus, highlighting the diagnostic challenges in such scenarios.
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Libiran et al. (2026) conducted a case report in Rheumatic mitral stenosis and suspected left atrial appendage thrombus (n=1). Transesophageal echocardiography (TEE) vs. Direct surgical inspection was evaluated on Detection of left atrial appendage thrombus. Preoperative and intraoperative transesophageal echocardiography falsely suggested a left atrial appendage thrombus that was disproven by direct surgical inspection during mitral valve replacement.
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