Transesophageal echocardiography during percutaneous mitral commissurotomy in patients with left atrial thrombus.

ABSTRACT

BACKGROUND: Transesophageal echocardiography (TEE) is used routinely before percutaneous transvenous mitral commissurotomy (PTMC) to detect left atrial appendage thrombus (LAAT) to avoid the risk of embolic complications. The issue of whether patients with small and fixed LAAT should be denied the potential benefit of PTMC is worth examining. OBJECTIVE: To evaluate the safety and efficacy of PTMC with Inoue balloon catheter in mitral stenosis patients with LAAT using TEE continuous monitoring during the procedure. Material and Method: All TEE studies performed during PTMC and transthoracic echo-cardiography (TTE) performed the same day and repeated on the day after the procedure between March 1995 and January 2000 were reviewed. RESULTS: A total of 1,238 consecutive TEE during PTMC were reviewed. LAAT was detected in 111 patients (mean age 43.7 +/- 10.1 years, malefemale = 12, atrial fibrillation sinus rhythm 2.471). LAAT were grossly oval with the largest measuring 3.5 x 2.8 centimeters. Mobile LAAT was detected in 3 patients (2.7%), one of whom developed a transient ischemic attack and another had an episode of stroke after PTMC. Mitral valve area (by 2D Echocardiography) pre PTMC was 0.8 +/- 0.2 cm2 and post-PTMC was 1.5 +/- 0.3 cm2. Most of our patients became fully ambulatory and could be discharged from the hospital the day after the procedure, except for two patients who developed severe mitral regurgitation and needed elective mitral valve surgery thereafter. CONCLUSION: PTMC with the Inoue-balloon catheter can be carefully and safely performed in patients with small, fixed LAAT under continuous TEE guidance with acceptable risk.