Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?

Daimee, Mudassir Ali; Salama, A; Cherian, George; Hayat, Nasser J.; Sugathan, T.N.

doi:10.1016/s0167-5273(98)00128-4

Cited by 30 publications

(39 citation statements)

References 45 publications

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“…Hemodynamically significant mitral stenosis, 8,9 mitral prosthesis, 10 or severe aortic regurgitation, 11 which were common in our study population (45% of our patients), are associated with LA stasis. Mitral regurgitation may decrease LA stasis and protect against LA thrombus formation, and although recently described, 16 aortic stenosis (or aortic prosthesis) usually does not result in significant LA stasis unless accompanied by left ventricular dysfunction.…”

Section: Valve Diseasementioning

confidence: 72%

“…(1) Valve disease, mitral stenosis (at least moderate in severity), 8,9 previous mitral valve surgery (valve replacement or repair), 10 or severe aortic regurgitation; 11 (2) Left ventricular dysfunction: severe systolic dysfunction (ejection fraction Ͻ30%) 12 or severe diastolic dysfunction (morphological 13 and hemodynamic 14 features of restrictive cardiomyopathy: mitral inflow E to A velocity ratio Ͼ2, pulmonary venous systolic less than diastolic flow velocities, moderate or greater LA enlargement, and preserved left ventricular systolic function). Valve disease and left ventric-ular dysfunction are referred to as "high-risk" structural heart disease.…”

Section: Methodsmentioning

confidence: 99%

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Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

et al. 2002

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Background-Left atrial (LA) thrombus is infrequently detected in the presence of sinus rhythm (SR) and, in these cases, is usually associated with additional cardiac pathologies. We sought to determine the clinical and echocardiographic characteristics of patients with LA thrombus and SR to define a high-risk group of patients prone to this uncommon clinical presentation. Methods and Results-The institution's echocardiographic laboratory database was searched to identify patients with LA thrombus, diagnosed by transesophageal echocardiography (TEE), who were in SR during the TEE examination. Of 20 643 consecutive TEE examinations performed during an 11-year period, LA thrombus was detected in 314 patients in 380 TEE examinations. Of these, SR was present in 20 patients (age 69Ϯ13 years; 40% men) in 23 examinations (0.1% of all TEE examinations; 6.1% of TEE examinations with LA thrombus). High-risk structural heart disease (severe left ventricular dysfunction or significant left-sided valve disease [predominantly mitral valve disease]), previous documented episodes of atrial fibrillation, or both (structural heart disease and previous atrial fibrillation) were present in 10, 4, and 5 of the 20 patients, respectively.

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Section: Valve Diseasementioning

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

et al. 2002

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“…6 Even patients of MS in sinus rhythm with depressed LA and LAA function are at increased risk of CVA. 7 Assessment of LAA function is helpful in predicting the risk of thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

“…9 Mitral valve area (MVA) is increased during balloon dilatation by commissural splitting. 10 Transoesophageal echocardiography (TEE) allows semi-invasive, highly accurate imaging of the functional efficiency of LAA by LAA Doppler and Doppler tissue imaging (DTI) flow profile 7 MS causes decreased LAA Doppler and DTI velocities in patients even with sinus rhythm. 4,11 Very few studies in the literature have evaluated the impact of PBMV on LAA function so far.…”

Section: Introductionmentioning

confidence: 99%

Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: Transesophageal echo study

Reddy

Rajasekhar

Vanajakshamma

2012

Indian Heart Journal

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“…Patients with mitral stenosis who remain in sinus rhythm usually have blood stasis with left atrial dilation and systolic dysfunction of the atrial body and the LAA, which might provide the anatomic and functional substrate for thrombus formation, with the ensuing risk of systemic thromboembolism and the need to adopt preventive therapeutic measures [18,19].…”

Section: Discussionmentioning

confidence: 99%

Right and left atrial appendage function in patients with mitral stenosis and sinus rhythm

Cianciulli

Saccheri

Lax

et al. 2009

Int J Cardiovasc Imaging

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Tissue Doppler imaging (TDI) is generally used for the assessment of ventricular function, and to a lesser extent, to evaluate the left atrial appendage (LAA). In the present study, we used TDI to analyze the contractile function of the right atrial appendage (RAA). The aim of this study was a comprehensive evaluation of RAA and LAA contractile function in patients with mitral stenosis and sinus rhythm. A total of 69 patients were assessed: group 1 (23 patients with severe MS, 38 +/- 11 years, 20 women), group 2 (23 patients with mild MS, 39 +/- 12 years, 19 women) and group 3 (23 healthy subjects, 42 +/- 14 years, 16 women). Multiplane transesophageal echo was performed in all patients. The RAA was visualized at 130 degrees and the LAA at 0 degrees . TDI sample volume was placed in the tip of both atrial appendages, with an ultrasound beam angle < 10 degrees . Flow velocities and myocardial velocities were measured. The presence of thrombus and/or spontaneous echo contrast (SEC) was assessed. TDI showed in normal subjects, myocardial contraction velocities in RAA similar to that of the LAA (21.8 +/- 4.2 vs. 20.1 +/- 4 cm/s, respectively, P = NS). In patients with MS, myocardial velocities in both atrial appendages were significantly lower than in normal subjects (RAA: 17.4 +/- 5.1 vs. 21.8 +/- 4.2 cm/s, respectively, P < 0.01, LAA: 9 +/- 5.1 vs. 20.1 +/- 4 cm/s, respectively, P < 0.001). Linear regression analysis showed a correlation between the impairment of systolic function of both appendages, pulmonary arterial pressure, valve area and transmitral gradient. Of the 46 patients with MS, patients with intense SEC had lower flow and myocardial velocities in the LAA than patients without SEC (16 +/- 5 vs. 50 +/- 3 cm/s, 6 +/- 2 vs. 10.6 +/- 5.6 cm/s, respectively, P < 0.001 and P < 0.001). In healthy subjects, myocardial contraction velocities in both appendages were similar. Patients with MS and sinus rhythm had contractile dysfunction of both appendages, shown by the decrease in myocardial velocities and related to the increase in atrial afterload. Both appendages exhibited a relation between contractile dysfunction and the presence of SEC, but dysfunction was less marked in the RAA, which might explain the lower prevalence of thrombi in the RAA.

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Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?

Cited by 30 publications

References 45 publications

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: Transesophageal echo study

Right and left atrial appendage function in patients with mitral stenosis and sinus rhythm

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