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REVIEW ARTICLES

Echocardiographic assessment of the left atrial appendage

^a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received March 6, 1999; revised manuscript received June 29, 1999, accepted September 7, 1999.

Reprint requests and correspondence: Dr. Bijoy K. Khandheria, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905

The left atrial (LA) appendage is a common source of cardiac thrombus formation associated with systemic embolism. Transesophageal echocardiography allows a detailed evaluation of the structure and function of the appendage by two-dimensional imaging and Doppler interrogation of appendage flow. Specific flow patterns, reflecting appendage function, have been characterized for normal sinus rhythm and various abnormal cardiac rhythms. Appendage dysfunction has been associated with LA appendage spontaneous echocardiographic contrast, thrombus formation and thromboembolism. These associations have been studied extensively in patients with atrial fibrillation or atrial flutter, in patients undergoing cardioversion of atrial arrhythmias and in patients with mitral valve disease. The present review summarizes the literature on the echocardiographic assessment of LA appendage structure, function and dysfunction, which has become an integral part of the routine clinical transesophageal echocardiographic examination.

Abbreviations and Acronyms   AF = atrial fibrillation   AFL = atrial flutter   LA = left atrium (-ial)   LAA = left atrial appendage   LV = left ventricle (-icular)   SEC = spontaneous echocardiographic contrast   SPAF = Stroke Prevention in Atrial Fibrillation   TEE = transesophageal echocardiography

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