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Coronary arteriography and atrial thrombosis in mitral valve disease
Insights
Coronary arteriography showing neovascularity and fistula formation can help diagnose left atrial thrombosis in mitral valve disease patients. These specific arteriographic findings are highly specific for atrial thrombus presence.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Neovascularity and fistula formation from coronary arteries to the left atrium are occasionally reported with atrial thrombosis in mitral valve disease.
- The diagnostic value of these arteriographic findings requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of preoperative coronary arteriographic findings (neovascularity and fistula formation) for detecting left atrial thrombosis in patients undergoing mitral valve surgery.
Main Methods:
- A review of preoperative coronary angiograms from 507 patients who underwent open mitral valve surgery.
- Correlation of arteriographic findings with the presence of atrial thrombosis identified during surgery.
Main Results:
- Atrial thrombosis was present in 14.9% of patients (76 out of 507).
- In 30 patients with neovascularity and fistula formation originating from the circumflex coronary artery, none had atherosclerotic lesions.
- An atrial thrombus was confirmed intraoperatively in 25 of these 30 patients.
- The arteriographic findings demonstrated a predictive accuracy of 83.3%, specificity of 98.8%, and sensitivity of 32.8% for left atrial thrombus.
Conclusions:
- Coronary arteriographic neovascularity and fistula formation are highly specific indicators of left atrial thrombosis in selected mitral valve disease patients.
- While sensitivity is limited, these findings significantly aid in the preoperative diagnosis of atrial thrombosis.
Abstract:
The arteriographic findings of neovascularity and fistula formation from the coronary arteries to the left atrium have occasionally been reported in association with atrial thrombosis in patients with mitral valve disease. To establish the diagnostic value of these findings, the preoperative coronary angiograms of 507 patients who underwent open mitral valve surgery were reviewed. Atrial thrombosis was present in 76 patients (14.9 percent). In the 30 patients with angiographic neovascularity and fistula formation, the thrombi were always observed to arise from the circumflex coronary artery. None of these 30 patients had atherosclerotic coronary lesions. In 25 of these patients an atrial thrombus was found at operation. These coronary arteriographic findings, in this selected group of patients, had a predictive accuracy of 83.3 percent, a specificity of 98.8 percent and a sensitivity of 32.8 percent for the diagnosis of the presence of thrombus in the left atrium. No relation was found between these signs and the size and histologic age of the thrombi examined.