case_images: PMC11784393_01
case_images: A: Preprocedural transesophageal echocardiography (TEE) revealed the absence of thrombus or spontaneous echocontrast (SEC) within the left atrial appendage (LAA). B: Successful occlusion of the LAA using a third-generation cryoballoon (yellow dashed contour):right anterior oblique 30  view. C: Postprocedural TEE at the third month indicated grade 2 SEC (white arrow), but there is no evidence of thrombus formation within the LAA. D: LAA velocity was measured at 0.24 m/s.
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case_images: PMC11784393_01_icrm-16-6158-g001.jpg
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case_images: Preprocedural transesophageal echocardiography (TEE) was performed under AF rhythm, and it indicated normal flow within the LAA with a velocity of 0.54 m/s and no evidence of spontaneous echocontrast (SEC) or thrombus formation (Figure 1A). To ensure optimal occlusion, contrast media was administered (Figure 1B). TEE indicated a reduction in LAA flow velocity (0.24 m/s) with grade 2 SEC, but there was no evidence of thrombus formation (Figures 1C and 1D).
case_images: A: Forty-four months after empirical left atrial appendage (LAA) isolation, transesophageal echocardiography (TEE) revealed the presence of a thrombus (white dashed contour) within the distal part of the LAA, and spontaneous echocontrast (SEC) in the proximal part of the LAA (white arrow). B: Following a 6-week period, a subsequent TEE was performed, and the LAA thrombus remained persistent, while the SEC had resolved (white dashed contour).
case_images: icrm-16-6158-g002.jpg
case_images: PMC11784393_01_icrm-16-6158-g002.jpg
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case_images: However, preprocedural TEE revealed a thrombus in the distal part of the LAA with a flow velocity of 0.38 m/s (Figure 2A). Furthermore, the percutaneous LAA closure procedure was planned for the patient (Figure 2B).