FREQUENCY OF LEFT ATRIAL AND APPENDAGE CLOT IN PATIENTS WITH SEVERE MITRAL STENOSIS

Authors

  • Mahmood ul Hassan
  • Cheragh Hussain
  • Adnan Mahmood Gul
  • Hikmat ullah Jan
  • Mohammad Hafizullah

Abstract

Background: Left atrial thrombus is common in patients with mitral stenosis and atrial fibrillation; buthow frequent it is in our population? The objective of study was to see the frequency of left atrial andappendage clot on trans-oesophageal echocardiography in symptomatic patients with severe mitralstenosis planned for PTMC. Methods: Trans-oesophageal echocardiographic data retrieved fromcomputer database Cardiology department, Lady Reading Hospital, Peshawar from August 1998 toMach 2008. Patients admitted for PTMC under went trans-oesophageal echocardiography for detectionof left atrial and appendage clot and quantification of mitral regurgitation. Data was analyzed on SPSS.Results: Out of 1544 patients, males were 608 (39.4%), females were 936 (60.6%). Mean age was30.84±12.6. Mean age of males was 30.56±13.1 years and females were 31.02±12.6 years. Minimumage was 8 years and maximum was 76 years. The mean LA size was 43.82±2.12mm.Atrial fibrillationwas observed in 289 (18.7%).Overall clot was seen in 224 (14.5%) patients. Left atrial appendage clotseen in 202 (89.73%).LA clot seen in 9 (4.02%). LAA/LA clot seen in 14 (6.25%). No significantdifference was observed for clot among the gender distribution (p=0.42). Significant correlation wasobserved for clot in patients with AF and LA size ≥45 mm, (p>0.001). Conclusion: The frequency ofleft atrial and appendage clots on trans-oesophageal echocardiography in patients with severe mitralstenosis is common and more frequent in patients with AF and LA size ≥45 mm.Keywords: LA, LAA, CLOT, TEE, PTMC

References

Olson LJ, Subramanian R, Ackermann DM. Surgical

pathology of the mitral valve: A study of 712 cases spanning

years. Mayo Clin Proc 1987;62:22–7.

Olesen KH. The natural history of 271 Patients with mitral

stenosis under medical treatment. Br Heart J1962;52:741–7.

Deverall PB. Incidence of systemic embolism before and

after mitral valvotomy. Thorax 1968;23:530–5.

Quiñones MA, Douglas PS, Foster E, Gorcsan J 3rd, Lewis

JF, Pearlman AS, et al. ACC/AHA Clinical competence

statement on echocardiography: A report of the American

College of Cardiology/American Heart Association/

American College of Physicians- American Society of

Internal Medicine Task Force on Clinical Competence

(Committee on Echocardiography). J Am Coll Cardiol

;41:687–708.

Kannel WB, Abbott RD, Savage DD,Mc Namara PM.

Epidemiologic features of chronic atrial fibrillation: The

Framingham Study. N Engl Med 1982;306:1081–22.

Ozkan M, Kaymaz C, Kirma C. Predictors of left atrial clot

and spontaneous echo contrast in rheumatic

valve disease before and after mitral valve replacement. Am J

Cardiol 1998;82:1066–70.

Kronzon I, Tunick PA, Charney LH. Echocardiography as a

tool in the evaluation of conditions with a high likelihood of

cardiogenic embolism. Isr Med Assoc J. 2006; 8:768–72.

Goswami KC, Yadav R, Rao BM, Bahl VK, Talwar KK,

Manchanda SC. Clinical and echocardiographic predictors of

left atrial clot and spontaneous echo contrast in patients with

severe rheumatic stenosis: Prospective study in 200 patients

by transesophageal echocardiography. Int J Card

;73:273–9.

Ahmad R, Awan ZA. Atrial Clots And Their Correlation

With Various Denominators: A study of 26 cases. Pak J Med

Sci 2005;21(2):210–12.

Ali M., Abid AR, Mallick N.H, Shiekh S.S, Ahmad S.

Clinical and Echocardiographic Predictors of Left Atrial

Thrombus in Rheumatic Mitral Stenosis. Annals

;15(2):75–9.

Hwang JJ, Chen JJ, Lin SC, Tseng YZ, Kuan P, Lien WP, et

al. Diagnostic accuracy of transesophageal echocardiography

for detecting left atrial thrombi in patients with rheumatic

heart disease having undergone mitral valve operations. Am J

Cardiol 1993;72:677–81.

Karatasakis GT, Gotsis AC, Cokkinos DV. Influence of

mitral regurgitation on left atrial thrombus and spontaneous

echocardiographic contrast in patients with rheumatic mitral

valve disease. Am J Cardiol 1995;76:279–81.

Srimannarayana J, Varma RS, Anilkumar R, Balachnander J.

Prevalence of Left Atrial Thrombus in Rheumatic Mitral

Stenosis with atrial fibrillation and its response to

anticoagulation: a transesophageal echocardiographic study.

Indian Heart J 2003;55:358–61.

Downloads

Published

2010-06-02

Most read articles by the same author(s)

1 2 > >>