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[Two-dimensional echo-cardiographic study on left atrial thrombi in patients with a mitral prosthetic valve]
Insights
Two-dimensional echocardiography identified left atrial thrombi in 5 of 33 patients with prosthetic mitral valves. Giant left atrium is closely related to thrombus formation in these patients.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Prosthetic mitral valves are used to restore cardiac function.
- Left atrial thrombi can lead to thromboembolic complications.
- Two-dimensional echocardiography is a key imaging modality for cardiac assessment.
Observation:
- A study evaluated 33 patients (9 males, 24 females; age 21-61) with prosthetic mitral valves using two-dimensional echocardiography.
- Left atrial thrombi were detected in 5 patients, characterized as mass echoes attached to the posterior left atrial wall.
- Pre-operative thrombus presence did not clearly predict post-operative thrombus occurrence.
Findings:
- Patients with left atrial thrombi (Group A) exhibited significantly larger cardio-thoracic ratios (74.4% vs 58.1%) compared to those without (Group B).
- Group A also showed significantly greater left atrial dimensions (70.6 mm vs 51.6 mm) and longer pseudo-septalized left ventricular posterior walls (34.0 mm vs 12.8 mm).
- A significantly greater angle between the mitral annulus and interventricular septum (58.6° vs 18.8°) was observed in Group A, suggesting a giant left atrium.
Implications:
- The findings suggest a strong association between giant left atrium and the development of left atrial thrombi in patients with prosthetic mitral valves.
- These results highlight the importance of vigilant echocardiographic monitoring for thrombus formation in this patient population.
- Understanding this relationship can aid in refining patient management strategies and potentially reducing thromboembolic risks.
Abstract:
Two-dimensional echocardiographic study was performed to detect left atrial thrombi in 33 patients with a prosthetic mitral valve. The subjects were 9 males and 24 females and their ages ranged from 21 to 61 years (average 43.2 years). Their prosthetic valves consisted of 18 Hancock, three Carpentier-Edwards, four Björk-Shiley, four Starr-Edwards and four St. Jude Medical valves. Two-dimensional echocardiograms were obtained using a Toshiba SSH-11A echograph with an electronic phased-array scanner. The left parasternal, apical, subcostal and right parasternal windows were used to detect left atrial thrombi. In five of the 33 patients, a left atrial thrombus was demonstrated as a mass echo attached to the posterior wall of the left atrium. The clinical and echographic features of five patients with a left atrial thrombus (Group A) were compared to those of 28 patients without it (Group B). The average age at the time of operation was 44.6 +/- 9.7 years in Group A and 43.0 +/- 9.5 years in Group B, showing no difference between the two groups. In 10 of the 33 patients, a left atrial thrombus was confirmed by the initial operation. In only one of these 10 patients, a left atrial thrombus was demonstrated by post-operative two-dimensional echocardiographic examination. The presence or absence of a left atrial thrombus in the pre-operative stage did not clearly relate to the occurrence of a left atrial thrombus in the post-operative stage. The cardio-thoracic ratio was significantly greater (p less than 0.01) in Group A (74.4 +/- 6.3%) than in Group B (58.1 +/- 8.1%). Left atrial dimension by M-mode echocardiograms was significantly greater (p less than 0.05) in Group A (70.6 +/- 11.3 mm) than in Group B (51.6 +/- 7.7 mm). The length of the pseudo-septalized left ventricular posterior wall was longer (p less than 0.05) in Group A (34.0 +/- 11.5 mm) than in Group B (12.8 +/- 9.4 mm). The angle between the perpendicular to the mitral annulus and the upper part of the interventricular septum was significantly greater (p less than 0.01) in Group A (58.6 +/- 18.0 degrees) than in Group B (18.8 +/- 9.6 degrees). The characteristics observed in Group A were thought to be caused mainly by the giant left atrium. Therefore it is concluded that there is a close relationship between left atrial thrombi and the giant left atrium in patients with a mitral prosthetic valve.