INTERRELATIONSHIP BETWEEN RHYTHM, LEFT ATRIAL SIZE AND THROMBUS FORMATION IN PATIENTS WITH MITRAL STENOSIS
Keywords:Atrial thrombus, transthoracic echocardiography(TTE), Transesophageal echocardiography(TEE), percutaneous transluminal mitral commissurotomy(PTMC).
AbstractObjectives: To study the Interrelationship between rhythm, left atrial size and
thrombus formation in patients with mitral stenosis.
Methodology: This observational study was conducted in cardiology
department LRH Peshawar, from February to December 2011. Every patient with
severe mitral stenosis presenting for PTMC was evaluated before procedure for
spontaneous echo-contrast, left atrial size, LA/LAA thrombus and its types on
TTE and TEE. Baseline ECG of each patient was taken.
Results: A total of 176 patients with mitral stenosis were divided into 110 patients
in group I having sinus rhythm and 66 patients in group II having atrial fibrillation.
In group I, 40 (36.36%) were males compare to group II having 14 (21.21%).
Mean age of patient in group I was 33.13 years ± 13.82 as compared to 30.97±
8.86 years in group II. In group I, 29 (26.36%) had LA/LAA thrombus as
compared to 32(48.48%) in group II on TEE(p-value=0.003). In group I,
60(54.54%) patients had spontaneous echo contrast as compared to
58(87.87%) in group II on TEE ( p-value=0.000). Mean left atrial size in group I
was 4.2±0.52cm as compared to 5.3±0.71cm in group II ( p-value=0.000). In
patients with AF, LA/LAA thrombus was visualized in 10 (15.15%) on TTE as
compared to 32(48.48%) on TEE(p value=0.001).
Conclusion: Atrial fibrillation is frequently associated with left atrial enlargement
and thrombus formation in patients with mitral stenosis. The accessibility of the
left atrial appendage by TEE is better than TTE in detection of thrombi.