Success of Surgical Left Atrial Appendage ClosureAssessment by Transesophageal Echocardiography
Anne S. Kanderian, MD*,
A. Marc Gillinov, MD ,
Gosta B. Pettersson, MD, PhD,
Eugene Blackstone, MD and
Allan L. Klein, MD, FACC*,*
* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Figure 1 Patent Left Atrial Appendage After Suture Exclusion
This left atrial appendage is an example of a patent appendage that was previously excluded by sutures that have now dehisced. There is persistent communication of the left atrial appendage with the left atrium.
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Figure 2 Persistent Flow Into the Left Atrial Appendage after Suture and Stapler Exclusion
(A) The left atrial appendage has been excluded by closing off the orifice of the appendage cavity from the atrium by sutures. There is a color flow jet observed between the atrium and the appendage suggesting persistent flow and communication. (B) The left atrial appendage remains attached to the atrium and has been excluded by stapling. However, there is persistent flow in the appendage demonstrated by color Doppler, suggesting persistent communication between the atrium and the appendage.
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Figure 3 Remnant Left Atrial Appendage after Excision and Suture Exclusion
(A) An example of a left atrial appendage that has been excised is shown; however, a stump of the appendage (>1 cm) remains attached to the atrium and is referred to as remnant left atrial appendage. (B) The left atrial appendage has been excluded from the atrium by suturing. However, the position of the sutures leaves a remnant left atrial appendage (>1 cm), which remains in communication with the left atrium.
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Figure 4 Occurrence of LAA Thrombus in Unsuccessful Surgical Closure
Shown is the presence of left atrial appendage thrombus with unsuccessful surgical left atrial appendage closure by the 3 techniques: excision, suture exclusion, and stapler exclusion. LAA = left atrial appendage.
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