PERSISTENCE OF LEFT ATRIAL SPONTANEOUS ECHOCARDIOGRAPHIC CONTRAST AFTER PERCUTANEOUS MITRAL VALVULOTOMY - A STUDY IN THE TURKISH POPULATION

We evaluated the resolution of left atrial spontaneous echocardiograph ic contrast (SEC) using transesophageal echocardiography (TEE) and tra nsthoracic echocardiography (TTE) one day before and three days after percutaneous mitral balloon valvulotomy (PMV) in 56 consecutive patien ts with mitral stenosis. SEC was present in 43 patients (77%) before t he procedure. We associated the following parameters with pre-procedur e SEC; decreased forward (p=0.043) and backward (p=0.044) left atrial appendage (LAA) peak flow velocities, increased left atrial dimension (p=0.05), decreased mitral valve area (p=0.001), presence of atrial fi brillation (p=0.031), and increased pulmonary systolic pressure (p=0.0 1). In multivariate analysis, decreased forward LAA peak flow velocity (p=0.0724), and decreased mitral valve area (p=0.0026) were the signi ficant independent predictors for the presence of pre-procedure SEC. O n post-PMV transesophageal echocardiography, SEC was present in seven patients (13%). Analysis of this subgroup of patients showed them to b e in the lowest quintile of the preprocedure forward LAA peak flow vel ocities. They also showed smaller percentage and absolute increase in backward LAA peak flow velocities after PMV. We suggest continued left atrial muscular dysfunction as an explanation for the persistence of SEC, despite the excellent hemodynamic improvement. We explain the dra matic decrease in SEC after PMV, on the basis of the youth of our pati ent population, the high success rates attained with PMV, and the phys iopathologic mechanisms that may be in play in rheumatic mitral stenos is seen in developing countries.