Study of the fate of detectable left atrial thrombi at repeated tranesophagealechocardiography in patients with mitral stenosis

ABSTRACT

Previous studies did not encourage balloon mitral valvuloplasty [BMV] when left atrial and /or LAA thrombi are present. Patients with LA and/or LAA thrombi are considered at high risk for thromboembolic events. So it is considered a major cause of morbidity and mortality in patients with mitral stnosis. To investigate the fate and stability of LA and/or LAA thrombi under the effect of oral anticoagulation this study included thirty patients with mitral stenosis having LA and/or LAA thrombi detected by TEE. They were subjected to full anticoagulation therapy controlled by INR of 2-3. Repeated TEE were done three and six months later. According to the results of this study the patients were grouped into two main groups Group 1 included sixteen patients who had dissolved LA or LAA thrombi after anticoagulation therapy. It represented [53.33%] of all cases included in this study. In thirteen patients out of all the total sixteen patients representing group I, the thrombi were dissolved after three months therapy as they had clear LA and LAA in the second TEE study. They represented [81.25%] of group I and [43.33%] of all patients included in this study. In three patients the thrombi were dissolved after six month anticoagulation therapy, they represented [18.75%] of group I and [10%] of the whole patients included in this study. Group II which included eleven patients [36.66%] all of them had non dissolved thrombi in LA and LAA in spite of six months anticoagulation therapy, three patients were excluded from the study. In conclusion: Complete resolution of LA and/or LAA thrombi occurs in a considerable number of patients [53.33%]. Age of the patients, size of the left atrium and size of LAA or LAA thrombi are considered the only significant factors influencing thrombus resolution. No other clinical or echocardiographic parameters could influence thrombus resolution. Majority of LA andyor LAA thrombi dissolve in the first three months with less incidence of resolution in the next months