19. How to Evaluate Left Atrial Appendage Thrombus With TEE

In Episode 19 of TEE Time, Dr. Andreas Plackis explains how to evaluate the left atrial appendage (LAA) for thrombus using transesophageal echocardiography (TEE) and why it matters for stroke prevention, anticoagulation decisions, and intraoperative planning. He reviews key risk factors (atrial fibrillation, low-flow states, mitral stenosis), outlines when dedicated LAA imaging is essential, and presents a systematic TEE approach including multiplane views, Doppler velocity assessment, contrast use, and differentiation of spontaneous echo contrast, sludge, and true thrombus. When thrombus is discovered intraoperatively, management depends on surgical access and clinical context, with strategies focused on clot removal when feasible or anticoagulation and minimizing embolic risk when access is limited.   00:00 How to Rule Out LAA Thrombus on TEE (Episode 19 Intro) 00:48 Why LAA Clots Matter: Stroke Risk & Anticoagulation Implications 01:12 Risk Factors & When to Look: AFib, Low Flow States, Procedures 02:44 TEE Accuracy, Limitations, and the Differential for an LA/LAA Mass 03:50 Step-by-Step TEE Exam: Views, Color, Doppler Velocities, and 3D 05:16 Normal vs Thrombus Examples: What It Looks Like on TEE 06:30 Tips & Tricks: Contrast, Color Scale, Multi-Angle Sweeps, Image Optimization 08:31 SEC vs Sludge vs Thrombus: How to Tell Them Apart 09:56 Intraoperative Management: Surgical Options and Risk Tradeoffs 11:41 Wrap-Up, Next Episode Preview, and Subscribe   #TEE #Echocardiography #Anesthesia #Cardiology #CriticalCare #EmergencyMedicine #Sonographer #CardiacSurgery #FOAMed #POCUS #Ultrasound #Anesthesiology #Perioperative #CardiacAnesthesia #AnesthesiaPodcast #Anesthesiology #Echo #Surgery #AdvancedTEE #PerioperativeTEE #TTE #Sonography #TEETime #TransesophagealEchocardiography #BasicPTE #AdvancedPTE #PTEeXAM #ICU   DISCLAIMER: This podcast provides recommendations intended for educational purposes only and should not be used as the sole basis for making medical decisions. The information reflects expert opinions rather than scientifically-verified data, and no express or implied warranties are made regarding its accuracy, completeness, or fitness for any particular purpose. Listeners are encouraged to verify all information independently and consult additional reliable sources. Neither the authors, publishers, nor any parties involved assume responsibility for any errors, omissions, or outcomes resulting from the use of this material. All non-original material featured in this podcast is either used with explicit permission from the copyright owner or is believed to fall under the Fair Use provisions of U.S. copyright law for purposes such as education, commentary, and criticism. If you believe any material has been used improperly, please contact the author directly so the matter can be promptly reviewed and addressed.