19. How to Evaluate Left Atrial Appendage Thrombus With TEE (Transesophageal Echocardiography)
In Episode 19 of TEE Time, Dr. Andreas Plackis explains how to evaluate the left atrial appendage (LAA) for thrombus using transesophageal echocardiography (TEE) and why it matters for stroke prevention, anticoagulation decisions, and intraoperative planning. He reviews key risk factors (atrial fibrillation, low-flow states, mitral stenosis), outlines when dedicated LAA imaging is essential, and presents a systematic TEE approach including multiplane views, Doppler velocity assessment, contrast use, and differentiation of spontaneous echo contrast, sludge, and true thrombus. When thrombus is discovered intraoperatively, management depends on surgical access and clinical context, with strategies focused on clot removal when feasible or anticoagulation and minimizing embolic risk when access is limited.
00:00 How to Rule Out LAA Thrombus on TEE (Episode 19 Intro)
00:48 Why LAA Clots Matter: Stroke Risk & Anticoagulation Implications
01:12 Risk Factors & When to Look: AFib, Low Flow States, Procedures
02:44 TEE Accuracy, Limitations, and the Differential for an LA/LAA Mass
03:50 Step-by-Step TEE Exam: Views, Color, Doppler Velocities, and 3D
05:16 Normal vs Thrombus Examples: What It Looks Like on TEE
06:30 Tips & Tricks: Contrast, Color Scale, Multi-Angle Sweeps, Image Optimization
08:31 SEC vs Sludge vs Thrombus: How to Tell Them Apart
09:56 Intraoperative Management: Surgical Options and Risk Tradeoffs
11:41 Wrap-Up, Next Episode Preview, and Subscribe
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