Accuracy of commonly-used imaging modalities in assessing left atrial appendage for interventional closure: Review article

Ramez Morcos, Haider Al Taii, Priya Bansal, Joel Casale, Rupesh Manam, Vikram Patel, Anthony Cioci, Michael Kucharik, Arjun Malhotra, Brijeshwar Maini

Research output: Contribution to journalReview articlepeer-review

Abstract

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural.

Original languageEnglish (US)
Article number441
JournalJournal of Clinical Medicine
Volume7
Issue number11
DOIs
StatePublished - Nov 14 2018
Externally publishedYes

Keywords

  • 2D transesophageal echocardiography
  • 3D transesophageal echocardiography
  • Computerized tomography
  • Left atrial appendage
  • WATCHMAN occlusive device

ASJC Scopus subject areas

  • General Medicine

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