Which imaging modality is typically used to assess the anatomy of the left atrial appendage before LAAO?

Transesophageal echocardiography (TEE) is the preferred imaging modality to assess the anatomy of the left atrial appendage (LAA) prior to LAAO procedures. This technique provides detailed visualization of the left atrial appendage and surrounding structures, allowing for the assessment of its size, shape, and any presence of thrombus or other anatomical variations. The high-resolution images obtained through TEE are crucial for planning the intervention, as they guide the selection of the appropriate device and approach.

In particular, TEE can provide real-time imaging that helps assess the suitability of the appendage for occlusion and identify any anatomical challenges that might need to be considered during the procedure. This detailed evaluation is essential for minimizing the risk of complications and ensuring the effectiveness of the occlusion.

Other imaging modalities, while they have their uses, do not provide the same level of detail or utility for this specific purpose. For instance, computed tomography (CT) may also assess cardiac structures but is not as effective as TEE for the direct evaluation of the LAA anatomy in a real-time context. Magnetic resonance imaging (MRI) is less commonly utilized in this setting due to challenges in access and prolonged acquisition times. X-ray imaging does not provide adequate anatomical