Key result
Intraoperative TEE detects a new LAA mass despite a normal TTE 2 months prior.
Why the study?
Routine screening of the left atrial appendage for thrombi in patients undergoing open heart surgery has not been systematically investigated, despite potential benefits in patients with mitral valve disease and LV dysfunction.
Does intraoperative TEE detect LAA thrombus missed by preoperative TTE in a patient with AF undergoing valve surgery?
Case Report (n=1)
Does intraoperative TEE detect LAA thrombus missed by preoperative TTE in a patient with AF undergoing valve surgery?
Intraoperative TEE is crucial for detecting unsuspected LAA thrombi in patients undergoing open heart surgery, even if preoperative TTE was normal.
May support intraoperative TEE in AF valve surgery after normal preoperative TTE; single case leaves open routine adoption.
We report the case of a 60-year-old woman with atrial fibrillation, scheduled for aortic and mitral replacement.The intraoperative TEE revealed a new pedunculated mass in LAA protruding to LA. Preoperative TTE had been performed 2 months before, showing any mass inside.Routine screening of the LAA for thrombi in these patients has not been investigated systematically, but screening also may be beneficial in patients with mitral valve disease, and in patients with LV dysfunction, as an LAA thrombus may be present in the absence of AF.According to the latest guidelines, TEE should be used in all open heart procedures in order to: confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anesthetic and surgical plan accordingly, and assess the results of surgical intervention.Therefore, a thorough understanding of the LAA's echocardiographic evaluation and the consequences of its removal are essential for the anesthesiologist.
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Sara López Palanca (2017) conducted a case report in Atrial fibrillation (n=1). Intraoperative transesophageal echocardiography (TEE) vs. Preoperative transthoracic echocardiography (TTE) was evaluated. Intraoperative transesophageal echocardiography detected a new pedunculated mass in the left atrial appendage, despite a normal preoperative transthoracic echocardiogram 2 months prior.
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