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Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study.

Publication ,  Journal Article
Manning, WJ; Reis, GJ; Douglas, PS
Published in: Br Heart J
February 1992

OBJECTIVE: Systemic emboli related to atrial thrombi are a well known complication of percutaneous balloon dilatation of the mitral valve. The presence of left atrial thrombi therefore, is believed to be a contraindication to balloon dilatation. The purpose of this study was to determine the frequency of left atrial thrombi in patients referred for balloon dilatation of the mitral valve, the added benefit of pre-procedural transoesophageal echocardiography, and to identify factors that predicted left atrial thrombi. DESIGN: Prospective study over a 14 month period of 20 consecutive patients by cross sectional transthoracic echocardiography 24-48 hours before balloon dilatation of the mitral valve and by transoesophageal echocardiography immediately before the procedure. RESULTS: One patient had a left atrial thrombus detected by transthoracic study. Two patients (10%) had left atrial thrombi identified by transoesophageal echocardiography. In both valve dilatation was not attempted and the thrombi were confirmed at surgery. The remaining 18 patients all underwent successful balloon dilatation of the mitral valve without clinical evidence of an embolic event. No association was found between patient age, mitral valve area, transmitral gradient, left atrial size, presence of atrial fibrillation, severity of mitral regurgitation, cardiac output, or the presence of left atrial swirling and an increased prevalence of atrial thrombi. CONCLUSION: Left atrial thrombi are often seen despite long term systemic anticoagulation in patients referred for balloon dilatation of the mitral valve. The frequency of unsuspected left atrial thrombi detected by transoesophageal echocardiography was similar to the reported frequency of embolic events after balloon dilatation of the mitral valve. Transoesophageal echocardiography for the identification of left atrial thrombi is strongly recommended in all patients before balloon dilatation of the mitral valve including those treated with systemic anticoagulation and those who have had a normal transthoracic echocardiographic study.

Duke Scholars

Published In

Br Heart J

DOI

ISSN

0007-0769

Publication Date

February 1992

Volume

67

Issue

2

Start / End Page

170 / 173

Location

England

Related Subject Headings

  • Thrombosis
  • Prospective Studies
  • Mitral Valve Stenosis
  • Middle Aged
  • Male
  • Humans
  • Heart Diseases
  • Heart Atria
  • Female
  • Esophagus
 

Citation

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ICMJE
MLA
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Manning, W. J., Reis, G. J., & Douglas, P. S. (1992). Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study. Br Heart J, 67(2), 170–173. https://doi.org/10.1136/hrt.67.2.170
Manning, W. J., G. J. Reis, and P. S. Douglas. “Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study.Br Heart J 67, no. 2 (February 1992): 170–73. https://doi.org/10.1136/hrt.67.2.170.
Manning, W. J., et al. “Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study.Br Heart J, vol. 67, no. 2, Feb. 1992, pp. 170–73. Pubmed, doi:10.1136/hrt.67.2.170.

Published In

Br Heart J

DOI

ISSN

0007-0769

Publication Date

February 1992

Volume

67

Issue

2

Start / End Page

170 / 173

Location

England

Related Subject Headings

  • Thrombosis
  • Prospective Studies
  • Mitral Valve Stenosis
  • Middle Aged
  • Male
  • Humans
  • Heart Diseases
  • Heart Atria
  • Female
  • Esophagus