Echocardiographic assessment of the left atrial appendage
Yoram Agmon, MDa,
Bijoy K. Khandheria, MDa,
Federico Gentile, MDa and
James B. Seward, MDa
a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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Figure 1 Pathologic specimens of the LAA displaying its complex and extremely variable configuration, thus emphasizing the need for routine meticulous echocardiographic scanning of the appendage in multiple planes. A, Bilobed LAA (LAA is on right side of picture). B, Single-lobed LAA with an additional "appendix" at its distal end (outside the plane of main LAA body). C, Multilobed LAA (multiple small lobes). D, Multiplane transesophageal echocardiographic demonstration of a multilobed LAA (90° and 135° scanning in D-1 and D-2, respectively). The orifice of the LAA (LA–LAA junction) is marked by a pair of arrows in A to C. (A to C, Courtesy of Dr. W. B. Edwards, Department of Anatomic Pathology, Mayo Clinic.)
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Figure 2 A, Diagram of LAA flow in sinus rhythm. 1, LAA contraction; 2, LAA filling; 3, systolic reflection waves (positive and negative); 4, early diastolic LAA outflow (see text for details). B, Pulsed-Doppler tracing of LAA flow in sinus rhythm (flow signals 1 to 4 as in A).
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Figure 3 A, Pulsed-Doppler tracing of LAA flow in AF. Note the rapid fibrillatory flow waves, which are of higher velocity during ventricular diastole than systole (arrows; see text for details). B, Pulsed-Doppler tracing of LAA flow in AFL (with a 2:1 ventricular response). Flutter flow waves are, in general, slower and of higher velocity than fibrillatory flow waves.
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