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[Echocardiographic diagnosis of left atrial thrombosis (author's transl)]
Insights
Two-dimensional echocardiography (2DE) effectively detects left atrial thrombi (LAT) in heart surgery patients, particularly older clots. Recent thrombi may be harder to identify with this imaging technique.
Area of Science:
- Cardiovascular Imaging
- Cardiac Surgery
- Echocardiography
Context:
- Left atrial thrombi (LAT) are a significant concern in patients undergoing heart surgery for mitral valve disease.
- Preoperative diagnosis of LAT is crucial for surgical planning and patient management.
- Various imaging modalities are employed to detect these thrombi, each with potential limitations.
Purpose:
- To evaluate the diagnostic accuracy of M-mode and two-dimensional echocardiography (2DE) in identifying left atrial thrombi (LAT) in patients undergoing heart surgery.
- To compare the sensitivity of 2DE versus M-mode echocardiography and angiocardiography in detecting LAT.
- To assess the characteristics of LAT visualized by echocardiography, including shape, location, and echogenicity.
Summary:
- A study of 70 heart surgery patients found 6 with left atrial thrombi (LAT) during operation.
- Two-dimensional echocardiography (2DE) detected LAT in 5 out of 6 cases, showing good detail of shape and location, especially for older thrombi.
- M-mode echocardiography had limited success, and recent thrombi were more challenging to identify accurately with both methods.
Impact:
- 2DE with gray-scale imaging demonstrates high sensitivity for detecting left atrial thrombi (LAT), particularly older, well-defined clots within the left atrial cavity.
- The study highlights potential difficulties in visualizing recent-onset thrombi or fresh components of older thrombi using current echocardiographic techniques.
- Findings underscore the importance of 2DE in preoperative assessment for cardiac surgery, while acknowledging limitations for specific thrombus types.
Abstract:
70 consecutive patients undergoing heart surgery for mitral valve disease were studied: at operation 6 of them exhibited left atrial thrombi (LAT). Dimension of the thrombi varied from a hazel-nut to an orange, 4 of them adhered to the posterior atrial wall, 2 of these obliterated the left atrial appendage, one partially and the other totally, invading also the left atrial cavity as far as mitral orifice. In 5 cases LAT appeared of old onset, possibly with recent apposition; in one case the thrombus was mainly recent. All the cases had been assessed preoperatively using M-mode and two-dimensional echocardiography: the diagnosis of LAT was made in 5 pts, the only thrombus missed was the one located in the left atrial appendage. Angiocardiography was performed in 4 pts, showing left atrial thrombi in one case. Two-dimensional echocardiography (2D E) demonstrated a high sensitivity by revealing LAT in 5 cases out of 6, with good definition of shape and location. The LAT appeared as echoproducing masse with well defined borders and "muscle" density in 4 cases; in 3 they were seen protruding into the atrial cavity and in one case they were seen located above the posterior mitral leaflet. M-mode revealed multiple echoes parallel to the posterior atrial wall in the first 3 cases, whereas in the fourth it provided no particular finding for the diagnosis. In the only case of recent onset LAT, 2DE showed a single strong echo, parallel to the posterior atrial wall both in long and short-axis views, separated from the atrial wall by an echo-free space of 1.5 cm. Similar features resulted at the M-mode echocardiography. In conclusion, 2DE with gray-scale has an high sensitivity for detecting LAT, in particular when thrombi are old and located in the left atrial cavity. Recent onset thrombi are more difficult to demonstrate and it is possible that the "fresh" component of an old thrombus is missed.