942-45 Mitral Regurgitation and Left Atrial Thrombus in Rheumatic Mitral Valve Disease: A Clinicopathologic Study

Abstract

A total of 255 consecutive patients with rheumatic mitral valve disease, scheduled for surgery, were studied preoperatively by transthoracic echocardiography. Data were analyzed to determine the relationship between mitral regurgitation (MR) and left atrial thrombus (LAT) found at surgery. The mean age of our patients was 34 ± 11 years. Female to male ratio was 1.5/1. A LAT was found in 77 patients (30%). There were 30 with mild, 33 with moderate, and 17 with severe MR. Atrial fibrillation was found in 155 patients (59%) MR had an inverse relationship to LAT with the prevalence of the latter as follows: 37%, 33%, 9% and 0% in none, mild, moderate, and severe MR respectively (p < 0.0001). In atrial fibrillation, the prevalence of LAT in patients with predominant MR was 8.3% versus 54% in patients with predominant mitral stenosis (p < 0.0001). When MR was severe with atrial fibrillation (13 cases), LAT was not found whatsoever. In sinus rhythm, the prevalence of LAT was 0% in predominant MR and 14,5% in patients with predominant mitral stenosis (p < 0.0001). When in sinus rhythm, LAT was absent in 14 patients with moderate or severe MR. Prophylactic anticoagulation of symptomatic rheumatic mitral valve disease patients (requiring surgery) with predominant MR is not likely to be beneficial when MR is severe in atrial fibrillation; and when MR is moderate or severe in sinus rhythm.