Successful percutaneous transvenous catheter balloon mitral commissurotomy after warfarin therapy and resolution of left atrial thrombus

Abstract

Since the introduction of percutaneous transvenous mitral commissurotomy (PTMC) for the treatment of mitral stenosis by Inoue et al in 1984, 1 the balloon catheter intervention procedure has become an effective and safe alternative to surgical treatment in well-selected patients with symptomatic mitral stenosis. 2,3 In addition to severe mitral regurgitation, left atrial thrombus is considered to be a contraindication to the procedure. Left atrial thrombus is a frequent complication of mitral valve disease 4,5 To the best of our knowledge spontaneous resolution of left atrial thrombus has not been reported. We recently observed incidental resolution of thrombus in the left atrial cavity in 2 patients with severe rheumatic mitral stenosis after warfarin treatment for 7 months in 1 and 1 year in the other. PTMC, using the Inoue catheter balloon technique, 1 was performed successfully in both patients without thromboembolic complications. Our experience suggests that it may be worthwhile to manage patients with mitral stenosis and left atrial thrombus with warfarin treatment if their clinical and hemodynamic status does not warrant immediate surgery. If the thrombus resolves, PTMC can then be performed safely. However, a mobile thrombus in the left atrium is at high risk for systemic embolization, 5 and deserves urgent surgical intervention.