Isolated left atrial appendage (LAA) stenosis is a very rare entity that is almost always detected coincidentally with transesophageal echocardiography (TEE). The clinical consequences of this condition are still unknown, but thrombus formation is likely to occur in the narrowed area.
A 51-year-old female was admitted to an outpatient clinic due to the complaint of dizziness. Physical examination revealed a 2/4 diastolic murmur that was best heard at the apex without any other pathological finding. Transthoracic echocardiographic examination demonstrated mild mitral and tricuspid regurgitation and moderate rheumatic mitral stenosis (planimetric mitral valve area, 1.8 cm2 and diastolic gradient: maximum 12 mm Hg; mean 6 mm Hg). TEE showed LAA orifice stenosis with a 10-mm Hg gradient (Fig. 1). Color doppler examination at the orifice of the LAA flow were observed, persistent color flow Doppler between the left atrium and LAA was shown (Fig. 2) (Video 1). Thrombus was seen in LAA (Fig. 3). Cardiac magnetic resonance imaging showed LAA dilatation (Fig. 4, 5) (Video 2). The patient received warfarin for 6 weeks, and control TEE revealed no thrombus after anticoagulant treatment.
Figure 1.
Left atrial appendage orifice stenosis with a 10-mm Hg gradient
Figure 2.
Color flow Doppler between the left atrium and left atrial appendage
Figure 3.
Left atrial appendage with thrombosis
Figure 4.
Magnetic resonance image demonstrate left atrial appendage dilatation
Figure 5.
Magnetic resonance image demonstrate opacification of the left atrial appendage
LAA stenosis is a complication that occurs after incomplete surgical ligation of the atrial appendage, but our patient received no intervention. LAA color Doppler examination may lead to an increase in similar cases during the TEE examination process due to the rheumatic mitral valve. To the best of our knowledge, this is the first case report showing the LAA ostial stenosis associated with rheumatic mitral stenosis.
Video 1
Color flow Doppler between the left atrium and left atrial appendage
Video 1
Magnetic resonance imaging showing left atrium and left atrial appendage opacification
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