Introduction Since its introduction in 1984, Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become established as a safe and effective treatment for rheumatic Mitral Stenosis (MS).( Ben Farhat et al., 1998) 1 Chronic pressure and volume overload imposed by MS causes left atrial (LA) and Left Atrial Appendage (LAA) dysfunction. Risk of cerebrovascular accident (CVA) is increased approximately 17-fold in patients of MS in Atrial Fibrillation (AF) and is present even in patients of MS in sinus rhythm (SR). This study was undertaken to evaluate the effect of PTMC on LAA function by Trans-esophageal echocardiography (TEE) Doppler and Doppler Tissue Imaging (DTI). Methods Total 70 cases were enrolled in this study. Patients with symptomatic severe MS (Mitral Valve Area <1.5cm2), in SR, who underwent a successful PTMC during the period from May 2016 to May 2019 were selected. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, immediately after (within 24 h) & after 6 months of PTMC. Results There was non significant improvement in Left Atrial appendage fractional area change {LAAAC (%)} immediately Post PTMC but there was significant improvement at 6 months Post PTMC. There was significant increase in LAA PW Doppler velocities (LAAEDE, LAALDE and LAAF velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up. There was significant increase in LAA DTI velocities (E LAA , A LAA and S LAA velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up. Conclusion PTMC improves left atrial appendage function in patients with mitral stenosis.

Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA<1.5cm 2 ) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (E LAA Velocity, A LAA Velocity, S LAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.