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European Journal of Echocardiography Advance Access published online on March 19, 2007
European Journal of Echocardiography, doi:10.1016/j.euje.2007.01.006
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Left atrial appendage thrombus outside of a ‘successful’ ligation

Robert Donnino, Paul A. Tunick and Itzhak Kronzon*

New York University Medical Center, Department of Medicine, Cardiology Division, Echocardiography Laboratory, 560 First Avenue, New York, NY 10016, USA

Received 31 October 2006; accepted after revision 20 January 2007.

* Corresponding author. Tel: +1 (212) 263 5665; fax: +1 (212) 263 8461. E-mail address: itzhak.kronzon{at}med.nyu.edu (I. Kronzon).


  Abstract

A 79-year-old woman with severe aortic stenosis underwent aortic valve replacement surgery, and had ligation of the left atrial appendage (LAA) using an epicardial approach. On a post-operative echocardiographic evaluation, the distal portion of the LAA was excluded, leaving no communication with the left atrium. The proximal portion of the LAA, however, was in continuity with the circulation and a large thrombus was present within it. While previous reports of incomplete LAA ligation have involved disruption of the suture line, this present report describes a case of incomplete ligation due to persistence of the proximal portion of the appendage. Thus, thrombus formation occurred despite a ‘successful’ epicardial exclusion of the distal LAA.

Keywords: Left atrial appendage; Incomplete ligation; Thrombus; Transesophageal echocardiography


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