PREVALENCE OF INTRAATRIAL THROMBI ON TRAN SESOPHAGEAL ECHOCARDIOGRAPHY IN CARDIAC TRANSPLANT PATIENTS

The aim of this study was to determine the prevalence of intra-atrial thrombi or spontaneous contrast by transoesophageal echocardiography i n patients who underwent cardiac transplantation by Lower and Shumway' s technique. Transoesophageal echocardiography was performed in 52 tra nsplant patients (43 men, 9 women : average age 51 years) with a high frequency biplane transducer. After surgery, all patients received pla telet antiaggregant therapy, Despite this treatment, 4 patients had a sudden systemic embolic episode and were then placed on oral anticoagu lants. All patients were in sinus rhythm at the time of the examinatio n and some had signs of acute rejection on endomyocardial biopsy perfo rmed the same day. Spontaneous contrast was observed in 27 patients (5 2 %) and was associated with thrombosis in 15 patients (29 %). These t hrombi were located in the left atrial appendage in 8 cases, on the le ft atrial posterior wall in 5 cases and on the left atrial sutures in 2 cases. None of these thrombi had been detected by transthoracic echo cardiography. No significant difference was observed between those wit h and those without thrombosis with respect to left atrial dimensions, left ventricular ejection fraction, cardiac index, pulmonary pressure s and the number of episodes of acute rejection. The 4 patients with a history of arterial embolism all had an intra-atrial thrombus. This s tudy demonstrates a high incidence of spontaneous contrast and intraca rdiac thrombi in the dilated left atrium of patients transplanted by L ower and Shumway's technique. It also underlines the value of transoes ophageal echocardiography in the follow-up of transplant patients. The therapeutic implications of these results would be systematic anticoa gulant therapy in transplant patients with a high risk of thromboembol ism because of intra-atrial thrombosis or spontaneous contrast, and al so the modification of surgical techniques with everted sutures and, a bove all, total cardiectomy.