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Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic

N K Shrestha, F L Moreno, F V Narciso

    Circulation
    |February 1, 1983
    PubMed

    Insights

    Two-dimensional echocardiography shows moderate accuracy in detecting left atrial thrombi in rheumatic heart disease patients. The imaging technique missed nearly half of all thrombi, especially those in the left atrial appendage.

    Area of Science:

    • Cardiology
    • Medical Imaging
    • Cardiac Surgery

    Background:

    • Rheumatic heart disease (RHD) frequently leads to left atrial abnormalities, increasing the risk of thrombus formation.
    • Accurate detection of left atrial thrombi is crucial for preventing thromboembolic complications, particularly before cardiac surgery.
    • Two-dimensional echocardiography (2DE) is a primary imaging modality used to assess cardiac structures and detect thrombi.

    Purpose of the Study:

    • To evaluate the diagnostic accuracy of two-dimensional echocardiography (2DE) in identifying left atrial thrombi in patients with rheumatic heart disease undergoing mitral valve surgery.
    • To determine the sensitivity and specificity of 2DE for left atrial thrombus detection in this specific patient population.

    Main Methods:

    • Prospective study involving 293 patients with rheumatic heart disease undergoing open-heart mitral valve surgery over 18 months.
    • Two-dimensional echocardiographic recordings were reviewed for the presence of left atrial thrombi.
    • Diagnostic confirmation of thrombi was based on direct intraoperative inspection and histopathologic examination.

    Main Results:

    • Two-dimensional echocardiography identified left atrial thrombi in 33 of 293 patients, with 30 confirmed intraoperatively and histopathologically (specificity 98.8%).
    • The overall sensitivity of 2DE for detecting left atrial thrombi was 58.8%, as 21 thrombi were missed.
    • Of the missed thrombi, 11 were located in the left atrial appendage (entirely missed by 2DE), and 10 were in the left atrial cavity. Excluding appendage thrombi, 2DE sensitivity for cavity thrombi improved to 75.0%.

    Conclusions:

    • Two-dimensional echocardiography demonstrates high specificity but limited sensitivity for detecting left atrial thrombi in patients with rheumatic heart disease.
    • The left atrial appendage remains a challenging location for 2DE detection, contributing significantly to missed diagnoses.
    • Further advancements or complementary imaging techniques may be necessary to improve the comprehensive detection of left atrial thrombi in this high-risk group.

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