Resolution of left atrial spontaneous echocardiographic contrast after percutaneous mitral valvuloplasty: Implications for thromboembolic risk

• Published in: The American heart journal 1995, Vol.129 (1), p.65-70
• Main Authors: Leung, Dominic Y.C., Black, Ian W., Cranney, Gregory B., McCredie, R.Michael, Hopkins, Andrew P., Walsh, Warren F.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular system; Catheterization - methods; Catheterization - statistics & numerical data; Echocardiography - instrumentation; Echocardiography - methods; Echocardiography - statistics & numerical data; Echocardiography, Transesophageal - instrumentation; Echocardiography, Transesophageal - methods; Echocardiography, Transesophageal - statistics & numerical data; Female; Heart Atria - diagnostic imaging; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve Stenosis - complications; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - therapy; Prognosis; Prospective Studies; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - diagnostic imaging; Rheumatic Heart Disease - therapy; Risk Factors; Thromboembolism - epidemiology; Ultrasonic investigative techniques
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90044-6

Left atrial spontaneous echocardiographic contrast (SEC) is an important marker of increased thromboembolic risk in patients with mitral stenosis. To evaluate the effect of percutaneous transseptal mitral valvuloplasty (PTMV) on SEC, we performed transesophageal echocardiography 1 day before and 3 months after PTMV on 88 consecutive patients. SEC was present in 65 (74%) patients before PTMV and was associated with absence of moderate or severe mitral regurgitation ( p = 0.01), a smaller valve area ( p = 0.02), an older age ( p = 0.04), and atrial fibrillation ( p = 0.05). At 3 months, PTMV resulted in a mean absolute and relative increase in valve area of 0.54 ± 0.36 cm 2 and 53% ± 43%, respectively. SEC resolved in 37 patients but persisted in 28 (32%) patients at the 3-month study. The absolute and relative increase of valve area and worsened mitral regurgitation after PTMV were predictors of resolution of SEC, with the relative increase in valve area being the only significant predictor on multivariate analysis. PTMV frequently results in resolution of SEC, which may have important implications in reducing the thromboembolic risk in these patients.