At what level is the left atrial appendage (LAA) typically assessed on TTE?

The left atrial appendage (LAA) is typically assessed at the PSAX ( parasternal short axis) aortic valve level during transthoracic echocardiography (TTE). This view allows for optimal visualization of the LAA, enabling clinicians to evaluate its size, morphology, and any potential thrombi that may be present.

In the PSAX view, the heart's structures are displayed in a way that the LAA appears adjacent to the left atrium and anterior to the aortic root, making it easier to assess the appendage’s characteristics in relation to nearby anatomical structures. This is particularly important in clinical practice, as patients with atrial fibrillation may be at risk for thrombus formation in the LAA, highlighting the necessity for accurate imaging of this region.

Other views, such as the apical 4-chamber, subcostal, and sternal long axis views, may not provide as clear of an assessment of the LAA, as they focus on different aspects of cardiac anatomy and might not visualize the appendage adequately. The unique orientation and positioning of the LAA in relation to the aorta make the PSAX at the aortic valve level the most appropriate choice for evaluation.