Thrombus In Left Atrium Research Articles

Periprocedural stroke and atrial fibrillation ablation: to do transoesophageal echocardiography, or not to do transoesophageal echocardiography, that is the question

This editorial refers to ‘Impact of routine transoesophageal echocardiography on safety, outcomes, and cost of pulmonary vein ablation: inferences drawn from a decision analysis model’ by L.J. Gula et al. , on page 1550 and ‘Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation’ by K. Chilukuri et al. , on page 1543 Several complications may occur during or shortly after atrial fibrillation (AF) ablation. Some of them are relatively common, such as cardiac tamponade, but rarely have significant clinical consequences if managed adequately. Others are less common, such as stroke, but may lead to disabling sequelae. This has prompted the wide use of procedures and practises aimed at the reduction of cerebrovascular complications, such as high anticoagulation levels during the procedure or transoesophageal echocardiography (TEE) prior to ablation. However, neither the net clinical benefit nor the cost-effectiveness of these practises has been adequately validated. This should be considered relevant since some of these may themselves be associated with complications, limit the workflow of the ablation laboratory or increase costs. Two interesting papers in this issue of the Journal address the potential role of routine TEE prior to AF ablation.1,2 The paper by Chilukuri et al. 1 assessed the potential TEE predictors of periprocedural stroke during AF ablation, other than the left atrium (LA) thrombus. This is important since the majority of studies exploring the use of TEE prior to AF ablation have … *Corresponding author: Unidad de Electrofisiologia Cardiaca Robotizada (1a Planta), Hospital General La Paz, P. de la Castellana 261, 28046 Madrid, Spain. Tel: +34 619 97 4115; fax: +34 917 27 7290, E-mail: jlmerino{at}arritmias.net

E0573 Impact of ageing on the left atrium thrombus in patients with non-valvular atrial fibrillation

ObjectiveThis study sought to investigate the impact of ageing on left atrium thrombus in patients with non-valvular atrial fibrillation (AF).MethodsFour hundred and twenty-one consecutive patients with AF underwent transesophageal echocardiography...

Contrast echocardiography in the non-invasive diagnosis of giant aneurysm of the right atrial appendage

A 57 year-old male patient was admitted to our echocardiography laboratory to rule out thrombus in left atrium before electrical cardioversion of atrial fibrillation. Transoesophageal echocardiography (TEE) demonstrated in the bicaval view, the right atrial appendage measured 10 x 5 cm, area: 42 cm(2), volume: 229 mL (Figure, left). A quick injection of 15 cc of echo-contrast fluid (shaken saline/1 cc air), delivered via an antecubital vein, showed filling the right atrial appendage aneurysm (Figure, right). Idiopathic giant congenital aneurysm of the right atrium appendage is a very rare malformation. TEE with contrast echocardiography is very useful in the non-invasive diagnosis of giant right atrial appendage aneurysm.

Left Atrial Dissection Associated with Pulmonary Vein Cannulation

Left Atrial Dissection Associated with Pulmonary Vein Cannulation

Meckel's Diverticulum Ischemia Caused by Thromboembolism after Coronary Artery Bypass Grafting

A 75-year-old woman underwent emergency coronary artery bypass surgery after acute anterior wall myocardial infarction. Because of the presence of a local peritonitis, an emergency laparotomy was performed in which necrotizing Meckel's diverticulum was found and resected. Microscopically, sections through the diverticulum revealed a fresh thrombus occluded the arterial lumen of diverticulum. The patient had an uneventful postoperative course. We believe that the cause of Meckel's diverticulum ischemia was the development of atrial fibrillation with left atrium thrombus formation followed by embolic obliteration of Meckel's diverticulum feeding artery.

意識消失発作により発見された高齢者巨大左房内浮遊血栓の1例

意識消失発作により発見された高齢者巨大左房内浮遊血栓の1例

Elevated high sensitivity CRP levels in patients with mitral stenosis and left atrial thrombus

Stasis of blood in the left atrium (LA) due to mitral obstruction is the principal mechanism of LA thrombus formation in patients with mitral stenosis (MS). The purpose of this case-control study was to determine the additional contributions of abnormal homosysteine/folate/B12 levels, chronic inflammation and markers of a procoagulant state. We found that elevated hsCRP levels were associated with the presence of left atrial thrombus, independent of the influence of conventional parameters indicating the severity of MS and its consequences.

Pseudomyxoma Originating from the Interatrial Septum in a Heart Transplant Patient

This report describes the echocardiographic diagnosis of an intracardiac mass in a heart transplant patient. The typical morphology of the lesions, its attachment to the interatrial septum, and the absence of a nidus focus for thrombus formation led to the preoperative assumption that it was a myxoma. The mass was successfully excised at the time of operation and the patient had an uneventful recovery. Pathology findings revealed a thrombus. Thus, echocardiography may have limited specificity for the differentiation of intracardiac tumors and thrombus.

Textura de bioprótese mitral, função ventricular esquerda e formação de trombo: análise por ecocardiografia transesofágica e aplicação de bioescore

Facing the hypothesis of participation of mechanical stress as a cause of mitral bioprosthesis dysfunction, we decided to assess the relation of preservation of the texture of the mitral bioprosthesis leaflets with left ventricular function, in addition to the casual formation of thrombus in left atrium in patients with left ventricular dysfunction from the implant of mitral bioprosthesis. Forty 40 patients with mitral bioprosthesis through multiplane transesophageal echocardiogram were studied and divided in two groups: with left ventricular dysfunction (FE=0.40+/-0.09) since the bioprosthesis implant (20 patients: age 47.75+/-11.10 years old and surgery time 5.3+/-2.6 years) and with normal left ventricular function (FE=0.73+/-0.06) since the implant (20 patients: age 49.75+/-13.59 years old and surgery time 5.7+/-3 years). The texture of bioprosthesis leaflets was analyzed through a transesophageal echocardiographic score (FACIMT Bioscore): 1) Fusion of leaflets (score 1 to 3); 2) Apposition of tissues (score 1 to 3); 3) Calcium in leaflets (score 1 to 5); 4) Integrity of leaflets (score 1 to 3); 5) Motility of leaflets (score 1 to 4) and 6) Thickness of leaflets (score 1 to 3). The presence of thrombi in left atrium was assessed through multiplane scanning of the left atrium and left atrial appendage in the transesophageal study. There was no significant difference in the texture of bioprosthesis mitral position between the groups, for the total score (8.7+/-2.4 vs. 7.9+/-2.1, p=0.259), and for each analyzed item. A greater incidence of thrombi in left atrium and left atrial appendage was detected in patients with ventricular dysfunction (65% vs. 20%, p=0.004). The left ventricular dysfunction was not a protecting factor of the texture of bioprosthesis leaflets in mitral position in the tardive post-surgery period. The patients with left ventricular dysfunction showed a more favorable environment for the formation of thrombi in left atrium.

Application of a Miniaturized Biplane Transesophageal Echocardiographic Probe in Adults

Background. Standard multiplane transesophageal echocardiographic probes have large transducer tips that could increase patient discomfort, especially during esophageal intubation. A miniaturized biplane probe has been developed for pediatric use; however, its utility for adult patients is unknown.Methods. The miniaturized biplane imaging was tested in 48 anesthetized, ventilated adult patients during cardiac surgery and was compared with the standard multiplane imaging. We evaluated the image quality of cardiac structures and thoracic aorta using a five-grade scoring system. We also measured the left ventricular end-diastolic dimension (LVEDD, mm) and the peak flow velocity (cm/s) of the left atrial appendage (LAA) by pulsed-wave Doppler.Results. Esophageal intubation with the multiplane probe was unsuccessful in 1 patient, although this patient was successfully intubated with the biplane probe. There were no complications with either probe. The image qualities of the left ventricle, mitral valve, aortic valve, and ascending aorta by the biplane probe were inferior to those by the multiplane one. On the other hand, left atrium (LA), LAA, interatrial septum, aortic arch, and descending aorta were as well visualized by the biplane probe as by the multiplane one. The values of LVEDD and peak flow velocity of LAA were not different between the probes. LAA thrombus in 2 of 47 patients and aortic dissection (Stanford type A) in 7 were also well detected by both methods.Conclusions. The resolution of the two-dimensional images in the near fields of the miniaturized biplane probe was as good as the standard multiplane one. The miniaturized biplane probe was found to be applicable to the detection of LA or LAA thrombus and assessment of LAA function in adults.

Silent brain infarction in patients with rheumatic mitral stenosis.

Silent brain infarction (SBI) is defined as asymptomatic infarction areas detected in computerized tomography (CT) scans in patients without a history of stroke. The incidence of SBI is increased in CT or magnetic resonance imaging in patients with carotid stenosis and with atrial fibrillation (AF), but its relation with rheumatic mitral stenosis (MS), another major source of emboli, is uncertain. The aim of this study was to investigate the incidence of SBI in patients with MS. Fifty-three patients with MS (44 females and 9 males; range 25-52 years; mean age 38 +/- 7 years) diagnosed by transthoracic echocardiography (TTE) were enrolled in the study. Mitral valve calcification, left atrium (LA) dimension, and the presence of associating mitral regurgitation on TTE were recorded. Electrocardiographic evaluation was done for rhythm analysis and neurologic examination was performed prior to cerebral CT. Carotid artery Doppler examination was carried out in patients with SBI to exclude carotid artery lesions. Patients with a history of hypertension, diabetes mellitus, anticoagulant drug usage, presence of thrombus in LA, left ventricular segmental or systolic dysfunction, or other valve diseases were excluded from the study. The incidence of SBI was found to be 24.5% in patients with MS (47% cortical, 53% lacunar). SBI was observed to be significantly high in patients with LA dimension > 4 cm or in patients with AF (p < 0.05). The SBI incidence was markedly higher if AF was found with enlarged LA when compared with patients having sinus rhythm and small LA (p < 0.01). When moderate to severe mitral regurgitation was associated with MS, the SBI incidence was found to be lower (p < 0.05). Although SBI was higher in patients with MVA < 1.5 cm2, it was not statistically significant (p > 0.05). No significant correlation was found between calcific and noncalcific valves for SBI (p > 0.05). Our data suggest that SBI may be expected in about 1/4 of patients with MS. The presence of LA enlargement and AF increase the incidence of SBI in patients with MS, whereas the presence of moderate to severe mitral regurgitation decreases the incidence of SBI.

A complication of mitral stenosis: free floating ball thrombus in left atrium

Left atrial (LA) ball thrombus is a rare disorder. These ball thrombi are generally associated with mitral stenosis, and the restricted mitral orifice encloses the free-floating thrombus in the LA. There is a potential for fatal systemic emboli or mitral valve orifice occlusion that may result in sudden death. We report a rare case of free-floating ball thrombus (FFBT) in the left atrium with mitral stenosis. A 52-year-old woman with chronic mitral stenosis was admitted to the hospital for progressive dyspnea, palpitation and unconsciousness. Electrocardiography showed atrial fibrillation (AF). Echocardiography revealed rheumatic, thickened, and stenotic mitral valve, and FFBT in the left atrium. She was treated successfully with removal of ball thrombus and mitral valve replacement. The size of the ball thrombus was 30×25×15 mm and postoperative course was uneventful.

Clinical and echocardiographic characteristics of left atrial spontaneous echo contrast in sinus rhythm

OBJECTIVESIn this study we attempt to define the clinical and echocardiographic characteristics of patients with left atrial spontaneous echo contrast (LASEC) in sinus rhythm (NSR).BACKGROUNDLeft atrial spontaneous echo contrast in atrial fibrillation (AF) is associated with increased risk of thromboembolism. Little is known about its significance in NSR.METHODSWe reviewed reports of 1,288 transesophageal echocardiogram (TEE) studies done with a 5 MHz probe. Patients with swirling LASEC who were in NSR during TEE were analyzed. We compared them with a control group of 45 age matched patients selected to have NSR, left atrium (LA) >4.0 cm but no SEC.RESULTSSpontaneous echo contrast in NSR was noted in 24 patients (2%) and formed our study group. All patients with SEC had enlarged LA, mean 5.6 cm ± 0.6 cm. There was a higher prevalence of cerebrovascular accident (CVA) in patients with SEC when compared with controls with no SEC, 83% versus 56%, p = 0.02. Patients with SEC had larger LA, 5.6 versus 4.9 cm, p < 0.0001 and lower mean peak left atrial appendage emptying velocity (LAAEV), 38 versus 56 cm/s, p = 0.001. Thirteen percent of patients with SEC had LA thrombus as compared with none in the control group, p = 0.02. By multivariate analysis, SEC in NSR was found to be associated with CVA, larger LA size and decreased mean LAAEV. Even after adjusting for LA size, patients with SEC had a higher prevalence of CVA than controls, p = 0.03.CONCLUSIONSSpontaneous echo contrast in NSR occurs in patients with significantly dilated LA and depressed atrial function. Left atrial thrombus is noted in 13% of such patients despite NSR. Spontaneous echo contrast in NSR is associated with a higher prevalence of CVA. Further, SEC is found to be an independent and more powerful correlate of CVA than reduced LAAEV or atrial size. These data indicate that LASEC in NSR is a prothombotic condition.

Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?

Objective: To study the left atrial appendage (LAA) function and potential for embolization in severe mitral stenosis (MS). Background: Patients with MS and atrial fibrillation or in sinus rhythm develop systemic emboli. LAA function has not been well studied in sinus rhythm. Methods: Forty consecutive patients with MS (valve area ≤0.7 cm 2/m 2) were studied. LAA ejection fraction and peak emptying velocity were measured along with other data. Results: Patients were subgrouped according to LAA Doppler flow pattern. Group I ( n=13) in sinus rhythm had biphasic high velocity ≥25 cm/s. Group II ( n=13) in sinus rhythm had biphasic low velocity <25 cm/s. Group III ( n=14) in atrial fibrillation had multiphasic irregular flow <25 cm/s or no definite flow. The LAA ejection fraction and peak emptying velocity were strikingly different in all groups. They were lower in group II when compared to group I. Group II had intermediate risk for thromboembolism compared to Group I and III as judged by systemic embolization, spontaneous echo contrast, thrombus in left atrium and LAA. Conclusion: A subset of mitral stenosis in sinus rhythm at increased risk of embolization can be suspected by Doppler transesophageal echocardiographic LAA flow profile.

Free-Floating Ball Thrombus in Left Atrium.

Left atrial (LA) ball thrombus is a rare disorder. These ball thrombi are generally associated with mitral stenosis, and the restricted mitral orifice encloses the free-floating thrombus in the LA. There is a potential for fatal systemic emboli or mitral valve orifice occlusion that may result in sudden death. We report the case of a patient with tight rheumatic mitral stenosis in whom a ball thrombus was observed to bounce and rebound off the walls of LA on echocardiography. After the patient received anticoagulant therapy for 1 month, the thrombus was not found at surgery.

Free-floating but immobile ball thrombus in left atrium: diagnosis aided by transoesophageal echocardiography

A patient in whom a free-floating but immobile ball thrombus developed in the left atrium in association with mitral stenosis is reported. Certain unusual echocardiographic findings are described.

A case of mild mitral stenosis with free flowting ball thrombus in left atrium

A case of mild mitral stenosis with free flowting ball thrombus in left atrium

Free-floating ball thrombus in left atrium after mitral valve replacement: Surgical removal following embolization to the aorta

Free-floating ball thrombus in left atrium after mitral valve replacement: Surgical removal following embolization to the aorta

One Case of Mitral Stenosis combined with Tricuspid Insufficiency, Giant Right Atrium and Thrombus in Left Atrium

One Case of Mitral Stenosis combined with Tricuspid Insufficiency, Giant Right Atrium and Thrombus in Left Atrium