EARLY ASSESSMENT BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF LEFT ATRIAL APPENDAGE FUNCTION AFTER PERCUTANEOUS MITRAL COMMISSUROTOMY

Thirty-seven consecutively admitted patients with severe mitral stenos is underwent percutaneous mitral commissurotomy with a transthoracic a nd biplane or multiplane transesophageal echocardiographic examination before and between 24 and 48 hours after percutaneous mitral commissu rotomy. Thirty patients (81%) were in sinus rhythm and 7 were in atria l fibrillation. Left atrial appendage (LAA) function was evaluated in both the transverse and the longitudinal planes by planimetry and puls ed Doppler echocardiographic interrogation at the LAA outlet. Percutan eous mitral commissurotomy resulted in a twofold increase in mitral va lve area, and no severe mitral regurgitation occurred. With use of the planimetry method, them was no significant improvement in LAA ejectio n fraction, except in the transverse plane for patients in sinus rhyth m (p = 0.03), With use of Doppler method, 3 distinct flow patterns wer e observed before the procedure: a ''sinus pattern'' in patients in si nus rhythm, and a ''fibrillatory pattern'' (n = 3) or a ''no-flow patt ern'' (n = 4) in patients in atrial fibrillation. After commissurotomy , there was a marked increase in LAA peak Doppler velocity (+62%) and in LAA velocity time integral (+31%). Of the 4 patients in atrial fibr illation with a no-flow pattern, 2 had recovery of a typical effective fibrillatory flow pattern after the procedure. The increase in peak D oppler velocity after commissurotomy was related to the decrease or re gression in left atrial spontaneous echo contrast, and correlated with the increase in mitral valve area, the decrease in transmitral pressu re gradient, and the increase in cardiac index; improvement in valve f unction after successful percutaneous mitral commissurotomy is associa ted with early improvement in LAA function.