Research Article
Volume 7 Issue 5 - 2020
Incidence of Left Atrial Appendage Clot in Patients of Severe Mitral Stenosis - A Large Observational Study at a Tertiary Level Cardiac Centre In India
Awadhesh Kumar Sharma1*, Neeraj Prakash2, MM Razi1, Santosh Sinha3, Umeshwar Pandey4 and Ramesh Thakur4
1Assistant Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India
2Assistant Professor, Department of Cardiothoracic Surgery, LPS Institute of Cardiology, Kanpur, UP, India
3Associate Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India
4Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India
*Corresponding Author: Awadhesh Kumar Sharma, Assistant Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India.
Received: March 21, 2020; Published: April 14, 2020




Abstract

Mitral stenosis (MS) is constriction of mitral valve orifice area due to structural abnormality of the mitral valve apparatus. Most commonly it is because of chronic sequel of acute rheumatic fever. Normal valve area of mitral valve orifice is in between 4 - 6 cm2. To maintain proper flow of blood from left atria to left ventricle with decrease in mitral valve area, pressure in left atria and gradient across the valve increases according to Poiseuille’s law. Progressive narrowing resulting in mitral valve area of less than 1 - 1.5 cm2, termed as severe mitral stenosis. Critical mitral orifice stenosis and raised left atrial pressure result in dilation of left atrial cavity and onset of atrial fibrillation. Due to stasis of blood, sluggish flow of blood and atrial fibrillation, thrombus formation occurs in left atria/left atrial appendage (LA/LAA). The aims and objectives of this study was to see the frequency of left atrial and appendage clot formation on trans-esophageal echocardiography in symptomatic severe mitral stenosis patients planned for percutaneous mitral balloon valvotomy and relation of this thrombus formation with atrial fibrillation, spontaneous ECHO contrast (SEC) and LAA emptying velocity. This is first largest ever study done in patients with rheumatic heart disease from an endemic country comprising of 2000 subjects. On analyzing results it was reported that the frequency of left atrial and appendage clots on trans-esophageal echocardiography in patients with severe mitral stenosis is much higher as reported and more frequent in patients with AF (33%) and LAA emptying velocity < 25 cm/sec (60%), but patients with normal sinus rhythm are also at increased risk.

Keywords: Left Atrial Appendage Clot; Mitral Stenosis; Rheumatic Heart Disease; Left Atrial Emptying Velocity; Atrial Fibrillation

References

  1. Srimannarayana J., et al. “Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: A transesophageal echocardiographic study”. Indian Heart Journal 55 (2003): 358-361.
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  3. Davison G and Greenland P. “Predictors of left atrial thrombus in mitral valve disease”. Journal of General Internal Medicine 2 (1991): 108-112.
  4. Manning WJ., et al. “Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study”. Annals of Internal Medicine 11 (1995): 817-822.
  5. Krishnamoorthy KM., et al. “Usefulness of transthoracic echocardiography for identification of left atrial thrombus before balloon mitral valvuloplasty”. American Journal of Cardiology 9 (2003): 1132-1134.
  6. Abdelmoneim SS., et al. “Contrast echocardiography for assessment of left ventricular thrombi”. Journal of Ultrasound in Medicine 8 (2014): 1337-1344.
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  8. Manjunath CN., et al. “Incidence and predictors of left atrial thrombus in patients with rheumatic mitral stenosis and sinus rhythm: A transesophageal echocardiographic study”. Echocardiography 28 (2011): 457-460.
Citation: Awadhesh Kumar Sharma., et al. “Incidence of Left Atrial Appendage Clot in Patients of Severe Mitral Stenosis - A Large Observational Study at a Tertiary Level Cardiac Centre In India”. EC Cardiology 7.5 (2020): 31-40.

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