Related Experiment Video

Updated: Aug 11, 2026

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
04:48

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

Published on: November 28, 2018

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

S Tansuphaswadikul1, K Hengrussamee, T Chantadansuwan

  • 1Cardiology Unit, Central chest Hospital, Nonthaburi, Thailand.

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|February 21, 2002
PubMed

Insights

Percutaneous transvenous mitral commissurotomy (PTMC) is safe for patients with small, fixed left atrial appendage thrombus (LAAT) when guided by transesophageal echocardiography (TEE). Continuous TEE monitoring ensures procedural safety and efficacy in these cases.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Transesophageal echocardiography (TEE) is standard for detecting left atrial appendage thrombus (LAAT) before percutaneous transvenous mitral commissurotomy (PTMC) to prevent embolisms.
  • The clinical significance of small, fixed LAAT in patients undergoing PTMC warrants investigation.

Purpose of the Study:

  • To assess the safety and efficacy of PTMC using the Inoue balloon catheter in mitral stenosis patients with LAAT.
  • To evaluate the role of continuous TEE monitoring during PTMC procedures in this patient group.

Main Methods:

  • Review of 1,238 TEE studies performed during PTMC procedures.
  • Analysis of transthoracic echocardiography (TTE) data from the same day and the day after PTMC.
  • Correlation of TEE findings with procedural outcomes and complications.

Main Results:

  • Left atrial appendage thrombus (LAAT) was identified in 111 out of 1,238 patients (9%).
  • Mobile LAAT was found in 2.7% of patients with LAAT, with 2 experiencing thromboembolic events (TIA, stroke).
  • Successful PTMC improved mitral valve area (0.8 to 1.5 cm²) with most patients discharged the next day; two required surgery for severe mitral regurgitation.

Conclusions:

  • Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter is feasible and safe in patients with small, fixed left atrial appendage thrombus (LAAT).
  • Continuous transesophageal echocardiography (TEE) guidance is crucial for managing LAAT during PTMC, ensuring acceptable procedural risk.
Abstract

More Related Videos

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair08:31

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

Related Concept Videos

Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Regurgitation II: Clinical Features and Diagnostic Tests01:23

Mitral Regurgitation II: Clinical Features and Diagnostic Tests

Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...
Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...