Pre-procedural Planning for Left Atrial Appendage Closure: Transesophageal Echocardiography

TEE has been the gold-standard imaging modality for the conventional left atrial appendage occlusion (LAAO) procedure; however, cardiac CT is increasingly recognized as an excellent imaging modality for pre-procedural planning. During the pre-procedural TEE, it is imperative to take note of the presenting rhythm, the alterations of left ventricular preload, and the timing of TEE imaging acquisition (at left ventricular end-systole vs. end-diastole). It is also necessary to understand the anatomy of the LAA and the relationship between each region of the LAA (ostium, neck, body, and apex) and neighboring structures such as coronary arteries and mitral valvular annulus. In addition, it should be noted that each LAAO device requires specific measurements to determine appropriately the size of patient’s LAA.