Robot-Assisted Minimally Invasive Strategy for a Large Mobile Thrombus Originating From the Left Atrial Appendage

Figures

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  Figure 1. Contrast-Enhanced Cardiac Computed Tomography Demonstrating a Thrombus in the LAA (A) Axial view shows a well-defined filling defect (white arrow) within the contrast-filled left atrial appendage (LAA), consistent with thrombus. (B) Delayed-phase image confirms persistent low attenuation in the same region (white arrow), supporting the diagnosis of a true thrombus rather than slow flow. Ao = aorta; PA = pulmonary artery; LSPV = left superior pulmonary vein.

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  Figure 2. Transesophageal Echocardiographic Views of the LAA Thrombus (A) Biplane mid-esophageal view reveals a large thrombus (white arrow) filling the left atrial appendage (LAA) and extending toward the ostium. (B) Pulsed wave Doppler at the LAA orifice shows significantly reduced flow velocity.

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  Figure 3. Intraoperative and Gross Findings of Robot-Assisted Thrombectomy and LAA Closure (A) The thrombus (blue arrow) is seen protruding from the left atrial appendage (LAA) orifice under robotic endoscopic view. (B) En bloc extraction of the large, multilobed thrombus (blue arrow) is performed using robotic instruments. (C) The LAA is closed internally with a double-layer running suture after thrombus removal. (D) Gross specimen of the extracted thrombus, measuring 15 × 33 mm, showing a multilobed shape.