Cardiovascular Imaging of the Left Atrium in Patients With Structural Heart Disease: What Does the Interventionalist Need to Know?

Figures

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  Fig. 1. A secundum atrial septal defect visualized on transesophageal echocardiography. Top row: Transesophageal echocardiograms show the 2-dimensional dropout of the secundum interatrial septum at (A) 0° view, (B) 42° view, and (C) 121° view. Arrows point to the atrial septal defect. Bottom row: Transesophageal echocardiograms show color Doppler shunt flow across the secundum atrial septal defect in (D) 0° view, (E) 42° view, and (F) 121° view.

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  Fig. 2. Three-dimensional transesophageal echocardiograms show examples of atrial septal defects with unique shapes and sizes: (A) small and round, (B) large and round, (C) small and oval, and (D) large and oval. Defect size and shape can be used to help predict optimal implanted device size.1 Reproduced from Seo et al. Journal of the American Society of Echocardiography. 25(10), 1031-1040. Reprinted with permission from Journal of the American Society of Echocardiography (©2012). Elsevier. All Rights Reserved.

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  Fig. 3. Devices used to treat patent foramen ovale (PFO). A) Diagram of the Amplatzer Septal Occluder. The device consists of 2 disks that straddle the interatrial septal defect and can be easily deployed through venous access: (a) Left atrial disc, (b) device waist, and (c) right atrial disc. B) Diagram of an expanded sizing balloon for accurate measurement of minimum PFO diameter. C) Schematic of the Amplatzer TorqVue LP Delivery System: (a) loader, which introduces the device into the delivery catheter; (b) hemostasis valve with extension tube and stopcock, which allows flushing of the delivery system and controls back-bleeding; (c) delivery catheter, which provides a pathway through which a device is delivered; (d) delivery wire (optional), which attaches to the device to control its movement through the delivery catheter; and (e) plastic vise (optional), which attaches to the delivery wire, serving as a “handle” for detaching (unscrewing) the delivery wire from the device. Amplatzer, Amplatzer TorqVue, and TorqVue are trademarks of Abbott or its related companies. Reproduced with permission of Abbott, ©2024. All Rights Reserved.

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  Fig. 4. Transthoracic echocardiogram shows left atrial appendage (LAA) sizing before Watchman device deployment and LAA exclusion. A) Measurement of LAA diameter and depth; (B) X-plane LAA view at 45° and 135°.

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  Fig. 5. Watchman device. A) Photograph shows the Watchman left atrial appendage (LAA) closure device. B) Schematic shows the Watchman LAA closure device in anatomical position.3 Reproduced from Cueff et al. Heart. 97(9), 721-726. Reprinted with permission from Heart (©2011). BMJ Publishing. All Rights Reserved.

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  Fig. 6. Transesophageal echocardiograms were obtained during placement of the Watchman device. A) Intraprocedural positioning of the Watchman device. Imaging shows the confirmatory tugging of the device with the catheter still attached to the center of the device. B) Real-time imaging of residual flow on either side of the Watchman confirms accurate placement.

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  Fig. 7. Follow-up transesophageal echocardiography (TEE) images obtained after Watchman device insertion. A) TEE image obtained at 1-month follow-up shows a thrombus with a long, sinewy tail (arrow). B) Follow-up image shows that after continued anticoagulation, the thrombus resolved. Images courtesy of Abdi Rasekh, MD.