Left Atrial Appendage

Being able to assess the appendage for thrombus prior to cardioversion or ablation is one of the most common reasons to obtain a TEE. It is important to be able to identify variations in anatomy, find additional lobes and distinguish pectinate muscle from thrombus. 

The easiest angle to get the appendage is between 60 and 90 degrees. You will need to withdraw the probe a little from the level where you obtain the mid esophageal 4 chamber view and put a decent amount of antiflexion on the probe.

 

To scan through the appendage as you omniplane up you will need to add some counterclockwise rotation and as you omniplane down to 0 degrees you will need to add some clockwise rotation. This is shown the video above.