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Left atrial appendage closure

beyond the artifact

D’Amico, Gianpieroa,*; Mojoli, Marcoa,*; Buja, Paoloa; Tarantini, Giuseppea

Journal of Cardiovascular Medicine: December 2016 - Volume 17 - Issue - p e171–e173
doi: 10.2459/JCM.0000000000000081
Images in cardiovascular medicine

Transesophageal echocardiography (TEE) represents the gold standard technique to detect left atrial appendage (LAA) thrombosis. Several conditions may be erroneously interpreted as LAA thrombus at TEE, including artifacts mimicking thrombi. We report a case of a 78-year-old man with atrial fibrillation and contraindication to anticoagulation who was referred to our institution for percutaneous left appendage closure with a transcatheter trans-septal approach. Intraoperative transesophageal echocardiography revealed a thrombus-mimicking image, related to reverberations of left upper pulmonary vein ridge, located at twice the distance of the ridge from the transducer.

aDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy

*Gianpiero D’Amico and Marco Mojoli contributed equally to the writing of this article.

Correspondence to Giuseppe Tarantini, MD, PhD, Ospedale di Padova, Centro Cardiologico Gallucci, Clinica Cardiologica, Via Giustiniani 2, 35128 Padova, Italy Tel: +39 049 8212586; fax: +39 049 8212309; e-mail:

Received 3 December, 2013

Revised 24 February, 2014

Accepted 24 February, 2013

© 2016 Italian Federation of Cardiology. All rights reserved.