Echocardiographic Predictors of Left Atrial Thrombus in Patients With Severe Rheumatismal Mitral Stenosis

Abstract

Background: Rheumatismal mitral stenosis is less common today than it was several decades ago, but it is a common cause of mitral stenosis (MS) in the developing world. Mitral valve stenosis symptoms include fatigue, palpitations, and Shortness of breath especially with exertion. Objectives: The purpose of this prospective study was to determine the incidence of left atrial (LA) thrombus and the predisposing factors predicting its developments in patients with symptomatic rheumatismal mitral stenosis who underwent transesophageal echocardiography (TEE) planed for percutaneous transvenous mitral commissurotomy (PTMC). Patients and Methods: Patients who were referred to perform TEE before mitral balloon valvuloplasty enrolled the study. Data were analyzed by SPSS. Results: Out of 92 patients, females were 68 (73.91%). Mean age was 43.35 ± 13.94. They were classified into two groups based on the presence or absence of LA thrombus. Group A consisted of 21 patients (seven men and 14 women) with LA thrombus (mean age of 53.00 ± 15.70 years). Group B consisted of 71 patients (17 men and 54 women) without LA thrombus. There were no statistically significant differences between the two groups regarding age, sex, LA diameter, LA area, LA smoke, Trans-mitral mean pressure gradient, systolic pulmonary artery pressure, left ventricular ejection fraction and right ventricular function, but patients with LA clot had more LA appendage dysfunction, more frequent atrial fibrillation rhythm, and smaller mitral valve area (P = 0.020, 0.005 and 0.020 respectively) and the prevalence of MR was also lower in this group (P = 0.049). In our evaluation there was no statistically significant difference regarding the LA diameter or LA area in patients with or without LA smoke. Conclusions: The frequency of left atrial clots increased with the presence of LAA dysfunction, atrial fibrillation rhythm, and smaller mitral valve area. Presence of MR had protective effects against LA clots.