Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

We report three cases of chronic atrial fibrillation without anticoagulation admitted for acute lower limb ischemia in which embolic source was left atrial appendage (LAA) thrombus revealed only by transesophageal echocardiography (TEE). Transthoracic echography (TTE) revealed left atrial dilatation (LA) with no contrast or intracavitary mass. TEE revealed LA with spontaneous echographic contrast, low ostial emptying velocities and congenital morphology of LAA with older and organized thrombus or with echolucent centre (” beard-beark sign of recent and growing thrombus”) and thoracic aorta atheroma plaques. They were discharged on acenocumarol/ novel oral anticoagulant therapy. Two-dimensional echocardiography should be recommended in all patients with periprocedural acute peripheral embolism and TEE only in selected cases. Very high incidence of acute embolic ischemia is probably due to lack of preoperative anticoagulation more than to nontherapeutical anticoagulation (international normalized ratio INR<2).