Usefulness of multiplane transesophageal echocardiography in the recognition of artifacts and normal anatomical variants that may mimic left atrial thrombi in patients with atrial fibrillation

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Abstract

Background. Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. Methods. One hundred and sixty-four consecutive patients scheduled for cardioversion of atrial fibrillation (study population) and 30 patients (control group) undergoing mitral valve surgery were submitted to TEE using a multiplane probe in order to obtain a systematic evaluation of the LAA. The number of LAA lobes and the presence of thrombi and artifacts were evaluated. Results. The majority of the study patients had a bilobed (53.1%) or single-lobed (34.1%) LAA. Thrombi were identified in 6%. Artifacts were found in 38 cases (23.2%) and their position was localized precisely at a distance from the transducer which was twice that from the partition-bend between the left upper pulmonary vein and left appendage, suggesting a reverberation. No differences in echocardiographic parameters were found in patients with (group 1) or without (group 2) artifacts. Cardioversion was successful in a similar percentage of cases in the two groups (group 1 68%, group 2 76%) without complications. In controls, the percentages of a single- (33%) and bilobed (40%) left appendage were similar to those found in the study population. Artifacts were identified in 11 controls (37%); no thrombi were detected during surgical left appendage inspection in these cases. Conclusions. A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.

Original languageEnglish
Pages (from-to)797-802
Number of pages6
JournalItalian Heart Journal
Volume4
Issue number11
Publication statusPublished - Nov 2003

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Atrial Appendage
Transesophageal Echocardiography
Artifacts
Atrial Fibrillation
Thrombosis
Electric Countershock
Anatomy
Pulmonary Veins
Heart Atria
Transducers
Mitral Valve
Population
Control Groups

Keywords

  • Atrial fibrillation
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{344162a73e6c4c3a8c446fd817b4dd7e,
title = "Usefulness of multiplane transesophageal echocardiography in the recognition of artifacts and normal anatomical variants that may mimic left atrial thrombi in patients with atrial fibrillation",
abstract = "Background. Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. Methods. One hundred and sixty-four consecutive patients scheduled for cardioversion of atrial fibrillation (study population) and 30 patients (control group) undergoing mitral valve surgery were submitted to TEE using a multiplane probe in order to obtain a systematic evaluation of the LAA. The number of LAA lobes and the presence of thrombi and artifacts were evaluated. Results. The majority of the study patients had a bilobed (53.1{\%}) or single-lobed (34.1{\%}) LAA. Thrombi were identified in 6{\%}. Artifacts were found in 38 cases (23.2{\%}) and their position was localized precisely at a distance from the transducer which was twice that from the partition-bend between the left upper pulmonary vein and left appendage, suggesting a reverberation. No differences in echocardiographic parameters were found in patients with (group 1) or without (group 2) artifacts. Cardioversion was successful in a similar percentage of cases in the two groups (group 1 68{\%}, group 2 76{\%}) without complications. In controls, the percentages of a single- (33{\%}) and bilobed (40{\%}) left appendage were similar to those found in the study population. Artifacts were identified in 11 controls (37{\%}); no thrombi were detected during surgical left appendage inspection in these cases. Conclusions. A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.",
keywords = "Atrial fibrillation, Transesophageal echocardiography",
author = "Anna Maltagliati and Mauro Pepi and Gloria Tamborini and Manuela Muratori and Fabrizio Celeste and Elisabetta Doria and Claudia Galli",
year = "2003",
month = "11",
language = "English",
volume = "4",
pages = "797--802",
journal = "Italian Heart Journal",
issn = "1129-471X",
publisher = "Societa Italiana di Cardiologia",
number = "11",

}

TY - JOUR

T1 - Usefulness of multiplane transesophageal echocardiography in the recognition of artifacts and normal anatomical variants that may mimic left atrial thrombi in patients with atrial fibrillation

AU - Maltagliati, Anna

AU - Pepi, Mauro

AU - Tamborini, Gloria

AU - Muratori, Manuela

AU - Celeste, Fabrizio

AU - Doria, Elisabetta

AU - Galli, Claudia

PY - 2003/11

Y1 - 2003/11

N2 - Background. Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. Methods. One hundred and sixty-four consecutive patients scheduled for cardioversion of atrial fibrillation (study population) and 30 patients (control group) undergoing mitral valve surgery were submitted to TEE using a multiplane probe in order to obtain a systematic evaluation of the LAA. The number of LAA lobes and the presence of thrombi and artifacts were evaluated. Results. The majority of the study patients had a bilobed (53.1%) or single-lobed (34.1%) LAA. Thrombi were identified in 6%. Artifacts were found in 38 cases (23.2%) and their position was localized precisely at a distance from the transducer which was twice that from the partition-bend between the left upper pulmonary vein and left appendage, suggesting a reverberation. No differences in echocardiographic parameters were found in patients with (group 1) or without (group 2) artifacts. Cardioversion was successful in a similar percentage of cases in the two groups (group 1 68%, group 2 76%) without complications. In controls, the percentages of a single- (33%) and bilobed (40%) left appendage were similar to those found in the study population. Artifacts were identified in 11 controls (37%); no thrombi were detected during surgical left appendage inspection in these cases. Conclusions. A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.

AB - Background. Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. Methods. One hundred and sixty-four consecutive patients scheduled for cardioversion of atrial fibrillation (study population) and 30 patients (control group) undergoing mitral valve surgery were submitted to TEE using a multiplane probe in order to obtain a systematic evaluation of the LAA. The number of LAA lobes and the presence of thrombi and artifacts were evaluated. Results. The majority of the study patients had a bilobed (53.1%) or single-lobed (34.1%) LAA. Thrombi were identified in 6%. Artifacts were found in 38 cases (23.2%) and their position was localized precisely at a distance from the transducer which was twice that from the partition-bend between the left upper pulmonary vein and left appendage, suggesting a reverberation. No differences in echocardiographic parameters were found in patients with (group 1) or without (group 2) artifacts. Cardioversion was successful in a similar percentage of cases in the two groups (group 1 68%, group 2 76%) without complications. In controls, the percentages of a single- (33%) and bilobed (40%) left appendage were similar to those found in the study population. Artifacts were identified in 11 controls (37%); no thrombi were detected during surgical left appendage inspection in these cases. Conclusions. A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.

KW - Atrial fibrillation

KW - Transesophageal echocardiography

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M3 - Article

VL - 4

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SN - 1129-471X

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