Long-term left atrial thrombi after mitral valve replacement.

Area of Science:

• Cardiovascular Surgery
• Cardiac Imaging
• Thrombosis Research

Background:

• Left atrial (LA) thrombi can be a complication after mitral valve replacement (MVR).
• Understanding long-term risk factors and characteristics of these thrombi is crucial for patient management.

Purpose of the Study:

• To evaluate the risk factors and characteristics of long-term postoperative LA thrombi following MVR.
• To identify predictors for LA thrombi development in patients with mitral prosthetic valves.

Main Methods:

• Retrospective review of transthoracic echocardiography (TTE) data from 3117 patients with MVR history.
• Matched case-control study comparing 45 LA thrombi cases with 180 thrombi-free controls.
• Stepwise multiple regression analysis to identify independent predictors.

Main Results:

• The incidence of long-term LA thrombi was 1.4% (45 cases) with a median detection time of 58 months post-MVR.
• Independent predictors for LA thrombi included larger LA size (>55 mm), increased mitral valve pressure gradient (MVPG >6 mmHg), and reduced left ventricular ejection fraction (LVEF <50%).
• All identified thrombi were sessile and immobile, found in various LA locations.

Conclusions:

• Long-term LA thrombi after MVR are relatively infrequent.
• LA size, MVPG, and LVEF are significant predictors for LA thrombi in patients with mitral prosthetic valves.
• Close monitoring is recommended for patients at risk of developing LA thrombi post-MVR.