History Of Systemic Embolism Research Articles

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

Surgical management of nonbacterial thrombotic endocarditis in malignancy

BackgroundNonbacterial thrombotic endocarditis is commonly seen on heart valves in patients with malignant or collagen diseases. The natural prognosis of nonbacterial thrombotic endocarditis is reported to be poor due to underlying malignancy. Surgical indications and appropriate timing for surgery for nonbacterial thrombotic endocarditis and underlying malignancy have not been formally studied.Case presentationThe case was a 45-year-old woman who presented with a history of systemic embolization associated with occult malignancy. A preoperative transesophageal echocardiogram showed multiple mobile vegetations on the aortic and mitral valves. She underwent valve surgery to prevent recurrent embolization. Based on the histopathologic findings, she was diagnosed with nonbacterial thrombotic endocarditis. She subsequently underwent surgery for occult malignancy, which was diagnosed as endometrioid adenocarcinoma.ConclusionsAlthough surgical indications for nonbacterial thrombotic endocarditis remain unclear, valve replacement or repair and multidisciplinary treatment including surgical intervention are essential to prevent recurrent embolization in patients with nonbacterial thrombotic endocarditis associated with malignancy.

Practice Variation in Triple Therapy for Patients With Both Atrial Fibrillation and Coronary Artery Disease: Insights From the ACC's National Cardiovascular Data Registry.

The aim of this study was to test the hypothesis that in the United States substantial practice variation exists in triple therapy prescribing practices, unrelated to measured patient factors. Recent data have shown that the risk of bleeding on dual antiplatelet therapy and oral anticoagulation ("tripletherapy") is high, although the optimal strategy for patients with atrial fibrillation and coronary artery disease remains unclear. Using the PINNACLE (National Practice Innovation and Clinical Excellence) registry, we identified 79,875 unique patients with both atrial fibrillation/atrial flutter and myocardial infarction and/or coronary stenting within 12months. Using triple therapy as a binary outcome variable, we created a mixed-effects logistic regression model with patient factors as fixed effects and practice site as a random effect. Patient factors included age, sex, diabetes, congestive heart failure, hypertension, peripheral arterial disease, prior stroke or transient ischemic attack, history of systemic embolization, and dyslipidemia. The model was assessed with a median odds ratio to assess practice variation after adjustment for patient factors. After adjustment for patient factors, significant practice variation was suggested by a median odds ratio of 2.78 (95% confidence interval: 2.33 to 3.23). In particular, this suggests that 2 randomly selected practices would differ in their likelihood of prescribing triple therapy for an identical patient by a factor of nearly3. In the United States, there is substantial practice variation in prescribing triple therapy to eligible patients even after adjustment for patient clinical characteristics. These results suggest that opportunities exist toimprove the quality of careofthis sizable population.

Factors Associated with Proximal Carotid Axis Occlusion in Patients with Acute Stroke and Atrial Fibrillation

Patients with atrial fibrillation (AF) are more likely to exhibit proximal carotid axis occlusion than those without AF. However, clinical characteristics associated with proximal arterial occlusion (PAO) in acute stroke patients with AF are not fully known. This study was aimed to elucidate the factors correlated with PAO. Consecutive patients with acute ischemic stroke developed in the middle cerebral artery (MCA) territory and AF who underwent magnetic resonance angiography (MRA) within 24h from onset were retrospectively enrolled. Prior users of warfarin were excluded. Patients were divided into 3 groups based on the site of arterial occlusion: occlusion at the internal carotid artery (ICA), at the horizontal segment of the MCA (M1), and at the MCA branch orno identifiable occlusion. Clinical characteristics were compared between the 3groups, and the factors associated with proximal vessel occlusion were evaluated with ordinal logistic regression analysis. All variables identified on univariable analyses with P values less than .1 were entered into the model. A total of 244 patients (124 women, median 80years old [interquartile range 72-87], median National Institutes of Health Stroke Scale [NIHSS] score 16 [7-22]) were studied. MRA was performed median 2.7 h (1.5-8.9) after stroke onset. Occlusion site was the ICA in 34 patients, M1 in 78, and MCA branch or no occlusion in the remaining 132. As the occlusion site was more proximal, patients were older and more female, the initial NIHSS score was higher, levels of d-dimer and brain natriuretic peptide (BNP) were higher, and histories of heart failure and systemic embolism were more common. On multivariable ordinal logistic regression analysis, female sex (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.03-3.26), advanced age (OR 1.37, 95% CI 1.02-1.84 for every 10years), history of systemic embolism (OR 14.9, 95% CI 1.41-157.75), and higher BNP level (OR 1.03, 95% CI 1.01-1.07 for every 100pg/mL) were independent factors associated with the risk of occlusion at more proximal arteries. The risk was 2.68-fold higher (95% CI 1.28-5.61) in patients having 2 of the following factors: female sex, agemore than 80years, systemic embolism, and BNP greater than 250pg/mL; and 4.50-fold (2.11-9.59) higher in those having 3 or 4 of the 4 factors compared with those without any of these factors. Female sex, advanced age,history of systemic embolism, and higher BNP level were independently associated with more proximal carotid axis occlusion. Patients with AF having these factors may be prone to have relatively large thrombi in the heart.

Abstract WP166: Factors Associated with Proximal Carotid Axis Occlusion in Patients with Acute Stroke and Atrial Fibrillation

Background and purpose Patients with atrial fibrillation (AF) are more likely to exhibit proximal carotid axis occlusion than those without AF. However, clinical characteristics associated with proximal vessel occlusion (PVO) in acute stroke patients with AF are not fully known. This study was aimed to elucidate the factors correlated with PVO. Methods Consecutive patients with acute ischemic stroke in the anterior circulation and AF who underwent MRA within 24 h from onset were retrospectively enrolled. Prior users of warfarin were excluded. Patients were divided into 3 groups based on the site of arterial occlusion: occlusion at the internal carotid artery (ICA); at the horizontal segment of the middle cerebral artery (MCA, M1); and at the MCA branch or no identifiable occlusion. Clinical characteristics were compared between the 3 groups, and the factors associated with proximal vessel occlusion were evaluated with ordinal logistic regression analysis. All variables identified on univariable analyses with p values <0.1 were entered into the model. Results A total of 258 patients (127 women, median 80 years old [interquartile range 71-86], median NIHSS score was 15 [6-21]) were studied. MRA was performed median 2.9 h [1.6-10.3] after stroke onset. Occlusion site was the ICA in 34 patients, M1 in 78, and MCA branch or no occlusion in the remaining 146. As the occlusion site was more proximal, patients were older and more female, the initial NIHSS score was higher, levels of D-dimer and brain natriuretic peptide (BNP) were higher, and histories of heart failure and systemic embolism were more common. On multivariable ordinal logistic regression analysis, female sex (OR 2.02, 95%CI 1.15-3.56), advanced age (OR 1.37, 95%CI 1.02-1.85 for every 10 years), history of systemic embolism (OR 15.3, 95%CI 1.45-161), and higher BNP level (OR 1.04, 95%CI 1.01-1.09 for every 50 pg/ml) were independent factors associated with increasing the risk of shifting to a more proximal vessel occlusion category. Conclusion Female sex, advanced age, history of systemic embolism, and higher BNP level were independently associated with more proximal carotid axis occlusion. Patients with AF having these factors may be prone to have larger thrombus in the heart than those without.

Guidelines on oral anticoagulation with warfarin – fourth edition

Guidelines on oral anticoagulation with warfarin – fourth edition

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = -0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke.

Retained Left Atrial Catheter: A Case Report and Review of the Literature

We describe a patient in whom transesophageal echocardiography detected a portion of retained left atrial catheter that had been left in situ for 21 years after aortic valve replacement. Although thrombus was present on the catheter, the patient had no history of systemic embolization, potentially as a result of the use of chronic anticoagulation with warfarin. A review of the literature identified 8 previous cases of a retained left atrial catheter. Retained left atrial catheters can be easily detected with transesophageal echocardiography and appear to have a significant risk of thrombus formation and systemic embolization that warrants removal of the catheter when identified.

Antithrombotic Therapy in Valvular Heart Disease—Native and Prosthetic: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

This chapter about antithrombotic therapy in native and prosthetic valvular heart disease is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: For patients with rheumatic mitral valve disease and atrial fibrillation (AF), or a history of previous systemic embolism, we recommend long-term oral anticoagulant (OAC) therapy (target international normalized ratio [INR], 2.5; range, 2.0 to 3.0) [Grade 1C+]. For patients with rheumatic mitral valve disease with AF or a history of systemic embolism who suffer systemic embolism while receiving OACs at a therapeutic INR, we recommend adding aspirin, 75 to 100 mg/d (Grade 1C). For those patients unable to take aspirin, we recommend adding dipyridamole, 400 mg/d, or clopidogrel (Grade 1C). In people with mitral valve prolapse (MVP) without history of systemic embolism, unexplained transient ischemic attacks (TIAs), or AF, we recommended against any antithrombotic therapy (Grade 1C). In patients with MVP and documented but unexplained TIAs, we recommend long-term aspirin therapy, 50 to 162 mg/d (Grade 1A). For all patients with mechanical prosthetic heart valves, we recommend vitamin K antagonists (Grade 1C+). For patients with a St. Jude Medical (St. Paul, MN) bileaflet valve in the aortic position, we recommend a target INR of 2.5 (range, 2.0 to 3.0) [Grade 1A]. For patients with tilting disk valves and bileaflet mechanical valves in the mitral position, we recommend a target INR of 3.0 (range, 2.5 to 3.5) [Grade 1C+]. For patients with caged ball or caged disk valves, we suggest a target INR of 3.0 (range, 2.5 to 3.5) in combination with aspirin, 75 to 100 mg/d (Grade 2A). For patients with bioprosthetic valves, we recommend vitamin K antagonists with a target INR of 2.5 (range, 2.0 to 3.0) for the first 3 months after valve insertion in the mitral position (Grade 1C+) and in the aortic position (Grade 2C). For patients with bioprosthetic valves who are in sinus rhythm and do not have AF, we recommend long-term (> 3 months) therapy with aspirin, 75 to 100 mg/d (Grade 1C+).

Location, size, and morphologic characteristics of left atrial thrombi as assessed by transesophageal echocardiography in relation to systemic embolism in patients with rheumatic mitral valve disease

A systemic embolism (SE) is one of the most important complications in patients with rheumatic mitral stenosis; the documented frequency of SE in patients with mitral stenosis varies from 10% to 45%.1,2 In surgical and postmortem clinicopathologic series, left atrial (LA) thrombus has been associated with SE.1,2 Recently, in transthoracic and transesophageal echocardiographic studies, the presence of spontaneous echocardiographic contrast (SEC) and/or thrombus within the left atrium has been found to increase the risk of SE. There are a limited number of studies evaluating the association between the risk of SE and the location, size, and morphologic characteristics of LA thrombi.3,5 Recently, it was reported that both the size and mobile character of LA thrombi were associated with increased risk of SE.14 We aimed to assess transesophageal echocardiographic correlates of recent SE, with specific reference to size, location, and morphologic characteristics of LA thrombi, and to investigate whether the intensity of left atrial SEC is related to the characteristics of concomitant LA thrombi in patients with rheumatic mitral valve disease. • • • The study population comprised 474 consecutive patients (320 women and 154 men, mean age 40 16 years) with rheumatic mitral valve disease who underwent transthoracic and transesophageal echocardiography 1 to 5 days before mitral valve surgery. Patient characteristics are listed in Table 1. Pure or predominant mitral stenosis was diagnosed in 333 patients (70.2%) and mitral regurgitation in the remaining patients. Two hundred sixty-seven patients (56.3%) had atrial fibrillation, and the remaining patients were in sinus rhythm. A history of anticoagulation was noted in 72 patients with history of SE; 34 patients with a history of silent LA thrombi were diagnosed by previous routine transthoracic echocardiographic studies. The mean value of the international normalized ratio was 2.5 1.2 in patients with SE and 2.6 1.1 in patients without SE. Mean time interval between the SE and the transesophageal echocardiographic study was 19 6 days. Patients with potential cardiac sources of SE, such as prosthetic heart valves; infective endocarditis; severe left ventricular dysfunction with or without left ventricular mural thrombi; and LA mass such as myxoma, protruding atheroma, aortic dissection, patent foramen ovale, and intracardiac shunts were excluded from the study. In patients without a history of SE, the presence of severe carotid artery disease was excluded by absence of systolic murmur over the carotid arteries. Transthoracic and transesophageal echocardiographic examinations were performed by a 3.25-MHz transthoracic and a 5-MHz multiplane transesophageal probes connected to a Vingmed CFM800 echocardiographic system (Horten, Norway). Written informed consent was obtained from each patient before entry into the study, and the protocol was approved by the institutional review board. Transesophageal echocardiography was performed after 4 hours of fasting, under topical anesthesia with 10% lidocaine and conscious sedation with intravenous midazolam. The mitral valve area was measured by pressure halftime and planimetric methods.15 Pure or predomFrom the Departments of Cardiology and Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. Dr. Ozkan’s address is: Department of Cardiology, Kosuyolu Heart and Research Hospital, Kadikoy, 81020, Istanbul, Turkey. E-mail: memoozkan@ superonline.com. Manuscript received June 29, 2002; revised manuscript received and accepted November 12, 2002. TABLE 1 Clinical and Echocardiographic Characteristics of Patients

St. Jude medical valve prosthesis: An analysis of long-term outcome and prognostic factors

Between 1979 and 1984, 321 patients received 354 St. Jude Medical prostheses (194 aortic, 94 mitral, 1 tricuspid, and 32 multiple valve replacements). Follow-up was 96% complete (2967 patient-years; mean 9.5 years per patient). Actuarial event-free rates at 10 years and linearized rates (in parentheses) of late complications were as follows: embolism, 85.0% ± 2.3% (2.3% per patient-year); anticoagulant-related hemorrhage, 74.8% ± 2.7% (3.3% per patient-year); cerebrovascular accident, 81.8% ± 2.5% (2.6% per patient-year); prosthesis thrombosis, 98.5% ± 0.7% (0.1% per patient-year); endocarditis, 97.2% ± 1.1% (0.4% per patient-year); prosthesis dysfunction, 97.1% ± 1.0% (0.4% per patient-year); hemolytic anemia, 98.5% ± 0.7% (0.1% per patient-year); reoperation, 97.4% ± 1.0% (0.4% per patient-year); overall mortality, 63.3% ± 2.7% (4.2% per patient-year); and valve-related death (including sudden death), 84.7% ± 2.2% (1.4% per patient-year). Independent preoperative risk factors were as follows: (1) for embolism, cardiac failure as indication for operation and history of prior systemic embolism; (2) for cerebrovascular accidents, the same two factors and age; (3) for endocarditis, diabetes, chronic alcoholism, and aortic valve replacement; (4) for overall mortality, age, ejection fraction (or cardiac index or cardiothoracic index), chronic alcoholism, and history of systemic embolism; and (5) for valve-related death, chronic alcoholism, degenerative cause of valve disease, and prosthetic diameter 23 mm or smaller. Ninety percent of survivors were in New York Heart Association functional class I or II at the end of follow-up. In conclusion, this study confirms the excellent durability of the St. Jude Medical valve and the remarkable functional benefit for the majority of the patients. However, prosthesis-related complications are still common, particularly for small-diameter prostheses. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control(J Thorac Cardiovasc Surg 1997;113:134-48)

Multivariate analysis in the prediction of left atrial thrombi in patients with mitral stenosis

The prediction of left atrial thrombi based on clinical and investigative data was evaluated prospectively in 100 consecutive patients with significant mitral stenosis. Nineteen patients had left atrial thrombi by surgical findings. Age, atrial fibrillation, and mitral valve area were the variables that predicted the presence of left atrial thrombus, whereas sex, dimension of left atrium, history of systemic embolism, history of previous mitral valvuloplasty, and associated significant mitral regurgitation were not. Patients with atrial fibrillation have a sixfold increase in risk of atrial thrombi compared with patients in sinus rhythm. Transthoracic echocardiography detected 11 (58%) of 19 and transesophageal echocardiography detected 17 (89%) of 19 thrombi found by surgical inspection. Multivariate analysis showed that age and atrial fibrillation were the best predictors of left atrial thrombus. In general clinical practice, these variables could be used to predict left atrial thrombi in patients with mitral stenosis. However, in certain situations such as prior percutaneous balloon mitral valvuloplasty or prior electrical cardioversion, transesophageal echocardiographic examination should be used for high accuracy in the detection of extent and location of left atrial thrombi.

1021-56 Prevalence of Fibrin Strands at Transesophageal Echocardiography

Fibrin strands (FS) shown by transesophageal echocardiography (TEE) on the left heart valves have been associated with an increased risk of stroke and systemic embolism. However, some have argued that FS merely represent degenerative valve changes due to stress or aging. The prevalence of FS in patients with structurally normal or abnormal hearts is unknown, To determine the prevalence of FS, we reviewed multiplane TEE from 100 patients. Group 1 consisted of 50 consecutive patients referred with various diagnoses for TEE (23 M, 27 W, ages 18 to 79, mean 50 y). Group 2 consisted of another 50 consecutive patients in sinus rhythm with structurally normal hearts at TEE (28 M, 22 F, ages 17 to 76, mean 42 y). In Group 1, 3 of 20 patients (15%) evaluated for cardiac source of embolism showed FS, while 2 of 30 patients (7%) evaluated for other reasons showed FS. FS were seen on the mitral valve in 3 patients and on the aortic valve in 2 patients. Three (3) of the 5 valves with FS were structurally normal, while 2 were thickened. In Group 2 (patients with normal hearts by TEE), 9 of 27 patients (33%) evaluated for cardiac source of embolism showed FS, while only 1 of 23 patients (4%) evaluated for other reasons showed FS. FS were seen on the mitral valve in nine patients, while 1 patient had both mitral and aortic valve FS. Of 47 patients in both groups with a history of systemic embolism, 12 (25%) had FS. Of the remaining 53 patients referred for other reasons, 3 16%) had FS. (p &lt; 0.01). FS are frequently found at TEE in patients with a history of systemic embolism-even in structurally normal hearts. FS are an infrequent TEE finding in the absence of such a history.

Noninvasive Predictors of Systemic Embolism in Mitral Stenosis: An Echocardiographic and Clinical Study of 500 Patients

Few predictors of systemic embolism in patients with mitral stenosis have been identified by noninvasive methods. This study used the most powerful noninvasive diagnostic tool, transthoracic echocardiography, as well as other noninvasive clinical information to look for predictors. Five hundred consecutive patients with a mitral valve area of 2 cm2 or less were studied. They were divided into two groups: group 1 consisted of 143 patients with a history of systemic embolism and group 2 consisted of 357 patients with no history of systemic embolism. Using a stepwise logistic regression on a random subsample of 400 patients, 4 independent predictors were found: the presence of atrial fibrillation (p = 0.003, relative risk [RR] = 2.3, 95% CI = 1.3, 4.2), the absence of significant tricuspid regurgitation (p = 0.008, RR = 2.5, 95% CI = 1.3, 4.9), the absence of aortic regurgitation (p = 0.022, RR = 2.2, 95% CI = 1.1, 4.2), and the presence of left atrial smoky echoes (p = 0.039, RR = 1.7, 95% CI = 1.1, 3.0). When the above model, together with significant interaction terms, was applied to the remaining 100 patients, both the Hosmer-Lemeshow and Brown goodness-of-fit statistics were not significant (p = 0.888 and p = 0.248, respectively), indicating that the fit was adequate and the model was validated. Thus, important noninvasive predictors of systemic embolism in patients with mitral stenosis can easily be obtained. Subgroups of patients with high risk of systemic embolism can be identified. This may refine our therapeutic strategies to prevent the catastrophe of systemic embolism.

Classification of left ventricular thrombi by their history of systemic embolization using pattern recognition of two-dimensional echocardiograms

Although one can diagnose left ventricular (LV) thrombi by two-dimensional echocardiography (2DE), the factors associated with peripheral embolization, given a 2DE with LV thrombi, have not been well delineated. Therefore we looked at 2DE and clinical variables that included texture features in the 2DE of 38 patients whose 2DE had LV thrombi and questioned these patients to see if clinical embolization had occurred in the 8.9 ± 6.1 month (± SD) average follow-up period. Eight patients, four with acute myocardial infarction (AMI) and four with dilated LV and decreased LV systolic wall motion, had clinically apparent leg or brain emboli, whereas the remaining patients did not. Emboli occurred within a week of obtaining the 2DE in question. The variables considered were the age of the patient, the type of heart disease present, warfarin administration, exercise tolerance, standard M-mode measurements, LV dyssynergy by 2DE, clot size and mobility, and gray scale statistics which include run length, Sobel edge points followed by 50% gradient thresholding, gray level second-order statistics, offset 1 and gray level difference statistics, offset 1. The values of the variables were then entered into an expert system (Expert Ease) in order to achieve classification of patients into emboli versus no emboli groups, while using a minimal number of variables. The only variables that were needed included run length, long runs emphasis, gray level difference statistics (entropy, contrast, mean, and angular second moment), gray level second-order statistics (contrast), and warfarin status. When probability statistics were applied to this schema, its accuracy was predicted to be at least 96%. These results suggest that a small number of 2DE texture and clinical features can be used to detect LV thrombi that are at high risk for systemic embolization.

The clinical course of patients with severe “rheumatic” mitral insufficiency

This study has been concerned chiefly with the clinical course of adult patients with predominant rheumatic mitral insufficiency under medical management. It is based on a series of 42 patients followed medically, and a group of 115 patients who underwent cardiac surgery. These have been compared with a group of 138 patients proven to have pure mitral stenosis at surgery. The patients were similar in age and sex. Rheumatic fever had been diagnosed in more than half the patients with insufficiency, and subacute bacterial endocarditis had occurred more frequently, but a history of systemic embolism was less frequent in insufficiency than in stenosis. Strikingly different was the tendency of patients with insufficiency to develop atrial fibrillation and enlargement of the left ventricles and left atria, the latter often very marked. It has been shown that mitral insufficiency may exist in the symptom-free stage for many years, and many of these patients may be in atrial fibrillation and have large and even gigantic left atria, and left ventricular enlargement. Deterioration may be very slow, although sudden death may occur occasionally. The more malignant course and the difference in clinical profile of patients with ruptured papillary muscles or chordae tendineae is described in a group of 13 such patients. The implications of this study in connection with the selection of patients for cardiac surgery have been discussed.

PREOPERATIVE ANGIOCARDIOGRAPHIC DIAGNOSIS OF LEFT ATRIAL THROMBI IN MITRAL STENOSIS.

THE preoperative clinical diagnosis of left atrial thrombi is difficult. A history of systemic embolization does not necessarily indicate the presence of an atrial thrombus. A reliable method of diagnosing such thrombi in mitral stenosis before surgery is needed, because the presence of clot influences the choice of surgical technic and the operative risk. This report describes our experience with pulmonary-artery angiocardiography in the diagnosis of left atrial thrombi in 113 patients with mitral stenosis.Materials and MethodsThe records were reviewed of all 113 patients with predominant mitral stenosis who had cardiac catheterization with pulmonary-artery angiocardiography between July 1, . . .