Abstract
Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA<1.5cm2) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.
Highlights
Mitral stenosis is rare in developed countries, it has been recognised for more than 300 years
It was the first disease to be diagnosed with echocardiography, and the first valve lesion to be successfully treated by surgery or percutaneous balloon valvuloplasty
In Mitral Stenosis (MS) due to chronic pressure and volume overload there occurs gradual left atrial (LA) and Left Atrial Appendage (LAA) dilatation and dysfunction leading to reduced blood flow velocities which predisposes to thrombus formation and thromboembolic episodes [3]
Summary
Mitral stenosis is rare in developed countries, it has been recognised for more than 300 years. In this study we compared the LAA function in patients of severe rheumatic MS with and without SEC and correlated degree of SEC with LAA function and evaluated the effect of PTMC on SEC grading. In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading
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