The missing left atrial appendage.
A 34 year old man underwent a transesophageal echocardiogram (TEE) prior to implantation of a biventricular ICD and DC cardioversion, to exclude left atrium and left atrial appendage thrombus. He had a history of repaired tetralogy of Fallot as a child, Stickler syndrome, atrial flutter and was status post recent mitral valve replacement, pulmonary valve replacement and tricuspid valve repair. The left atrial appendage was not visualized on TEE. A cardiac CT clarified that there was a left atrial appendage and provided an explanation as to why it was not visualized on TEE, highlighting the importance of multimodality imaging in patients with complex congenital heart disease.
Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. niamhkilcullen@doctors.org.uk
Niamh M
NM
Kilcullen
James K H
JK
Woo
Suhny
S
Abbara
Conor D
CD
Barrett
Aaron
A
Baggish
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging*; D000328:Adult; D020517:Atrial Appendage / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods*