Thromboembolic events in Sudanese patients with rheumatic mitral stenosis

ABSTRACT

Background: Rheumatic mitral stenosis (MS) is a common problem in the Sudanese community, usually affecting the younger population. It can be a crippling condition with many complications, thromboembolism being one of the most serious. Objective:The aim of this study is to quantify the prevalence of thromboembolism and to identify its risk factors in Sudanese patients with MS at Ahmed Gasim Cardiac Centre. Methodology:Records of patients admitted from Jan 1999-Jan 2003, were retrospectively reviewed and data from various clinical and echocardiographic variables were recorded. Results:A total of 412 patients were studied, 142 (34.5%) were males, 270 (65.5%) were females. There were no significant differences in the gender (P = 0.606) or severity of symptoms between patients with and without thromboembolism. Patients with thromboembolism were older (P < 0.016), had more frequent atrial fibrillation (P = 0.017), smaller mitral valve area (P = 0.021) and higher pulmonary artery pressure (P = 0.012) compared to patients without thromboembolism. Dilated left atrial (LA) size was significantly associated with thromboembolism (P = 0.034), spontaneous echo contrast (P = 0.048) and the presence of LA or left atrial appendage (LAA) thrombus (P = 0.029). The presence of LA/LAA thrombus was significantly associated with both thromboembolism (P = 0.05) and spontaneous echo contrast (P < 0.0001). Transoesophageal echocardiography was more sensitive in detecting both spontaneous echo contrast (P < 0.0001) and LA/LAA thrombus (P < 0.0001) than transthoracic echocardiography. Conclusion: These results highlight the clinical and echocardiographic risk factors for thromboembolism, the sensitivity of transoesophageal echo for assessment of those patients, and the need for early referral for percutaneous transvenous mitral commisurotomy (PTMC)