Author + information
- Siobhan M. Lockwood, MBBS,
- Jeffery F. Alison, MBBS,
- Manoj N. Obeyesekere, MBBS and
- Philip M. Mottram, MBBS, PhD⁎ ()
- ↵⁎Address for correspondence:
Dr. Philip M. Mottram, Monash Heart, 246 Clayton Road, Clayton Victoria 3168, Australia
PATIENTS WITH ATRIAL FIBRILLATION (AF) HAVE INCREASED RISK for thromboembolic stroke, mainly from a thrombus originating in the left atrial appendage (LAA). Anticoagulation is thus recommended for patients with high risk for stroke but is often underutilized due to issues concerning its risk, need for monitoring, and compliance. Occlusion of the LAA with a device such as the LAA occluder (Watchman occluder, Atritech Inc., Plymouth, Minnesota) offers an alternate method of reducing thromboembolic risk in these patients. Imaging plays an important role in this procedure. Multiplanar transesophageal echocardiography (TEE) is performed to define LAA size and anatomy, including the presence of multiple lobes. The LAA is imaged from the mid-esophageal view through 180° (in particular at 0°, 45°, 90°, and 135°) to define the maximum LAA width and maximum depth of the dominant lobe. Both measurements are used to determine device size; the device can accommodate LAA widths ranging from 17 to 32 mm, as long as LAA depth exceeds width. Additionally, in our center, patients undergo multidetector cardiac computed tomography (MDCT) (320 slice) with contrast prior to occluder implantation for further evaluation of LAA anatomy. The images (Figs. 1, 2, 3, 4, and 5⇓⇓⇓⇓) illustrate the role of imaging before, during, and after this procedure.
The authors have reported that they have no relationships to disclose.
- American College of Cardiology Foundation