|Number 09-09 Left Atrial Appendage Clot and Atrial Fibrillation|
Number 09-09 Left Atrial Appendage Clot and Atrial Fibrillation
Case from: Raju Ailiani, Kevin Jaeger, Umang Patel, Tim Tisue, Marv Shear. Gundersen Lutheran Heart Institute, La Crosse, WI, United States.
Clinical history: A 62 year old male with DCM, chronic atrial fibrillation and multiple failed DC cardioversions and failed ablation, underwent video assisted thoracoscopic left atrial appendage amputation. CMR was requested to document the adequacy of the amputation.
2-Chamber Cine View
Cine Aortic Valve View CMR Angiography
Cine and Angio CMR: The CMR was successfully performed despite atrial fibrillation. TrueFISP cines (2-chamber and aortic valve view) identified the presence of a thrombus in the LAA. 2D angio image confirmed the persistence of a sizeable LAA despite previous video assisted thoracoscopic amputation with thrombus. Imaging of the LAA was also achievable owing to the fact that the motion of the LAA remains quite modest despite AF or tachycardia.
Repeat Cine and Angio CMR following 6 months of oral anticoagulation showed thrombus resolution.
2-Chamber cine with visible LAA Clot 2-Chamber cine 6 months post anticoagulation
CMR Angiography with visible LAA Clot CMR Angiography 6 months post anticoagulatio
Perspective: This is a nice example of how satisfactory imaging of the LAA was achievable without the need for semi-invasive TEE and also how high quality images are possible in patients in atrial fibrillation.
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