Echocardiographic Imaging Guidance for Left Atrial Appendage Closure: Transesophageal Echocardiography (TEE)

Transesophageal echocardiography (TEE) is regarded as the gold standard for visual intra-procedural guidance of left atrial appendage closure (LAAC). It is imperative to understand the different views and correlations of fluoroscopy throughout the procedure including confirmation of appropriate target site, ruling out exclusion criteria, deployment of the device, and post-deployment monitoring for complications. It is also important that multiple views (0, 45, 90, and 135 degrees) using TEE should be obtained both prior to and after device implantation to exclude thrombus, plan the procedure, and assess the device. Besides that, operators should become familiar with the appearance of different LAAC devices on TEE. In addition, immediately post-deployment, final views should be obtained to evaluate for pericardial effusion with comparison made to baseline imaging performed at the beginning of the case.