title: Predictors of left atrial thrombus and spontaneous echo contrast in rheumatic valve disease before and after mitral valve replacement.
abstract: In this study we aimed to analyze, with reference to mitral regurgitation (MR), the incidence and predictors of left atrial (LA) thrombus and spontaneous echo contrast in patients with rheumatic valve disease before and after mitral valve replacement. The incidence of LA thrombus is known to be less in patients with MR. The impact of mitral valve replacement on this beneficial effect has not been studied in detail. The study included 169 consecutive patients (59 men and 110 women, average age 40 +/- 13 years) with rheumatic mitral valve disease who underwent transesophageal echocardiographic examination 1 to 3 days before and within 7 days (mean 4.0 +/- 1.3) after mitral valve replacement using mechanical prostheses in a single institution. The preoperative incidence of echocardiographic LA spontaneous echo contrast (SEC) was 1.1%, 30%, and 54%, and the incidence of thrombus was 1.1%, 13%, and 17% in the groups with MR, combined mitral stenosis + MR, and isolated mitral stenosis, respectively. In the MR group, SEC and thrombus incidence increased significantly after surgery. The independent predictors for postoperative thrombus development were atrial fibrillation, postoperative SEC, and preoperative thrombus. Thrombus recurred after surgery in 64% of 14 patients who had surgical thrombectomy. The presence of postoperative MR was associated with decreased risk of postoperative SEC and thrombus development. The interaction between MR and SEC and thrombus both before and after surgery provides further support for the protective effect of MR against LA thrombus formation.
authors.affiliation: Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ozkan
authors.forename: C
authors.initials: C
authors.lastname: Kaymaz
authors.forename: C
authors.initials: C
authors.lastname: Kirma
authors.forename: A
authors.initials: A
authors.lastname: Civelek
authors.forename: A R
authors.initials: AR
authors.lastname: Cenal
authors.forename: C
authors.initials: C
authors.lastname: Yakut
authors.forename: U
authors.initials: U
authors.lastname: Deligonul
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*