title: [Left atrial appendage in rheumatic mitral valve disease: The main source of embolism in atrial fibrillation].
abstract: OBJECTIVE
  To demonstrate that surgical removal of the left atrial appendage in patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation decreases the possibility of stroke. This also removes the need for long-term oral anticoagulation after surgery.
  
  
  METHODS
  A descriptive, prospective, observational study was conducted on 27 adult patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation, who had undergone mitral valve surgery and surgical removal of the left atrial appendage. Oral anticoagulation was stopped in the third month after surgery. The end-point was the absence of embolic stroke. An assessment was also made of postoperative embolism formation in the left atrium using transthoracic echocardiography.
  
  
  RESULTS
  None of the patients showed embolic stroke after the third post-operative month. Only one patient exhibited transient ischaemic attack on warfarin therapy within the three postoperative months. Left atrial thrombi were also found in 11 (40.7%) cases during surgery. Of these, 6 (54.5%) had had embolic stroke, with no statistical significance (P=.703).
  
  
  CONCLUSIONS
  This study suggests there might be signs that the left atrial appendage may be the main source of emboli in rheumatic mitral valve disease, and its resection could eliminate the risk of stroke in patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation.
authors.affiliation: Departamento de Cirugía Cardiaca, Hospital de Cardiología UMAE 34, Instituto Mexicano del Seguro Social, , Monterrey, Nuevo León, México. Electronic address: ovidiocardiotor@gmail.com.
authors.forename: Ovidio A
authors.initials: OA
authors.lastname: García-Villarreal
authors.affiliation: Departamento de Cirugía Cardiaca, Hospital de Cardiología UMAE 34, Instituto Mexicano del Seguro Social, , Monterrey, Nuevo León, México.
authors.forename: José A
authors.initials: JA
authors.lastname: Heredia-Delgado
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D004617:Embolism / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000601:surgery*; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*
keywords: Atrial appendage; Atrial fibrillation; Atrial thrombus; Enfermedad reumática cardiaca; Fibrilación auricular; Mexico; Mitral valve; México; Orejuela; Rheumatic heart disease; Trombo auricular; Válvula mitral