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Case Reports
. 2016 Apr-Jun;26(2):52-55.
doi: 10.4103/2211-4122.183751.

Three-dimensional Transesophageal Echocardiography Demonstration of Left Atrial Appendage Echocontrast Regression after 6 Months Therapy with Dabigatran and not with Warfarin

Domenico Vestito  1 , Delia Desantis  1 , Paolo Colonna  1
Affiliations
Case Reports

Three-dimensional Transesophageal Echocardiography Demonstration of Left Atrial Appendage Echocontrast Regression after 6 Months Therapy with Dabigatran and not with Warfarin

Domenico Vestito et al. J Cardiovasc Echogr. 2016 Apr-Jun.

Abstract

While warfarin therapy is efficacious in treating left atrial (LA) thrombus formation in patients with nonvalvular atrial fibrillation (AF), it does not affect red cell aggregation in vitro or LA spontaneous echo-contrast in patients. In this patient with left ventricular (LV) dysfunction secondary to AF, we observed the disappearance of dense echo-contrast in the atrial appendage after therapy with dabigatran and not with well-controlled warfarin. This allowed us to analyze accurately the appendage with three-dimensional (3D) transesophageal echocardiography (TEE) excluding thrombi and to perform electrical cardioversion to obtain a significant improvement of LV function. This case demonstrates the capability of dabigatran and not of warfarin in reducing the intense spontaneous echocontrast in atrial appendage and the ability of 3D TEE in analyzing accurately the appendage, excluding thrombi to safely perform cardioversion.

Keywords: Atrial appendage; atrial fibrillation; cardioversion; dabigatran etexilate; three-dimensional echocardiography; transesophageal echocardiography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transesophageal echocardiography 80° section showing the presence of spontaneous echo-contrast with sludge effect in the enlarged left atrial appendage, visible also in the left atrium (arrow). Due to this echo-contrast, it is impossible to exclude the presence of thrombus in the atrial appendage. LA = Left atrium, LV = Left ventricle
Figure 2
Figure 2
Transesophageal echocardiography after 1 month of dabigatran; 80° section showing disappearance of spontaneous echo-contrast in the enlarged left atrial appendage; in correspondence of the lateral appendage wall, a thin wall thickening is visible hardly to differentiate between thrombus or pectinate muscles. LA = Left atrium, LV = Left ventricle
Figure 3
Figure 3
Three-dimensional transesophageal echocardiography 80° section after 1 month of dabigatran without echo-contrast in the atrial appendage; thanks to the three-dimensional analysis, it is possible to identify the small immobile linear formations in the lateral appendage wall (arrows) as pectinate muscles of the mid-distal portion. LA = Left atrium, LAA = Left atrial appendage, LUPV = Left upper pulmonary vein
See this image and copyright information in PMC

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