ECHOCARDIOGRAPHIC PREDICTORS OF LEFT ATRIAL THROMBUS FORMATION IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS

Abstract

Objective: To assess the factors responsible for left atrial appendage clotformation in patients with severe mitral stenosis employing transesophagealechocardiography.

Methodology: An observational cross sectional study was conducted onpatients with severe mitral stenosis who underwent transesophagealechocardiography before percutaneous transmitral commisurotomyfrom 1st August to31st December 2015. Patients were divided into two groups on the basis ofpresence or absence of thrombus. Group -1 Patients with thrombus while Group-2 patients included those without thrombus in left atria. Data were entered in theSPSS-20 and echocardiographic factors responsible for clot formation wereanalyzed.

Results: Out of 82 patients, 73 of patients were women. Mean age was35.87±11.8 years. Group 1 included 24 patients (women to men ratio 91:9).Group 2 included 58 patients(women to men ratio 88:12). Patients of both groupsdid not differ significantly regarding age, sex, systolic pulmonary artery pressureand mitral valve mean pressure gradient (MVMPG) but group 2 patients had lessfrequent atrial fibrillation (p 0.05), smaller left atrial size (p 0.05), biggermitral valve area and no low flow velocities (p 0.05) which indicated left atrialappendage dysfunction. Atrial fibrillation was observed in 35(42.7%) patientsand was significantly associated with thrombus formation i.e. 20(83.3%)patients.

Conclusion: It is concluded that frequency of left atrial thrombus formation isincreased in patients of rheumatic mitral stenosis with low left atrial appendageflow velocities, atrial fibrillation and smaller mitral valve area.