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Atrial endocardial changes in mitral valve disease: a scanning electron microscopy study
I Goldsmith1, P Kumar, P Carter
1Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
American Heart Journal
|October 31, 2000
Summary
Endocardial damage in the left atrial appendage (LAA) is more common in mitral valve disease, particularly mitral stenosis, increasing thrombus risk. These findings highlight LAA changes in mitral valve disease and atrial fibrillation.
Area of Science:
- Cardiology
- Pathology
- Biomedical Engineering
Background:
- Left atrial appendage (LAA) endocardial damage and dysfunction's role in thrombus formation in mitral valve (MV) disease, especially with atrial fibrillation (AF), is unclear.
- The LAA is a primary site for thrombus formation, making its condition critical in MV disease patients.
Purpose of the Study:
- To describe endocardial surface changes in the LAA and right atrial appendage (RAA) of MV disease patients using scanning electron microscopy.
- To compare these changes between mitral stenosis and regurgitation, and between AF and sinus rhythm.
- To correlate endocardial changes with plasma levels of von Willebrand factor (vWf) as a marker of endothelial damage.
Main Methods:
- Scanning electron microscopy of LAA and RAA specimens from 35 MV disease patients undergoing surgery.
- Classification of endocardial lesions as minimal, intermediate, or advanced.
- Measurement of plasma vWf levels and comparison with healthy controls.
Main Results:
- Advanced endocardial changes were significantly more frequent in the LAA (31%) than the RAA (6%).
- Mitral stenosis patients showed more advanced LAA changes (67%) than mitral regurgitation patients (24%).
- Plasma vWf levels were higher in MV disease patients and those with advanced LAA changes.
Conclusions:
- Endocardial damage is present in the atrial appendages of MV disease patients.
- Potentially thrombogenic changes are more prevalent in the LAA, especially in mitral stenosis.
- These findings suggest a mechanism for intra-atrial thrombus formation in MV disease, particularly with AF.