RESOLUTION OF LEFT ATRIAL SPONTANEOUS ECHOCARDIOGRAPHIC CONTRAST AFTER PERCUTANEOUS MITRAL VALVULOPLASTY - IMPLICATIONS FOR THROMBOEMBOLIC RISK

Left atrial spontaneous echocardiographic contrast (SEC) is an importa nt marker of increased thromboembolic risk in patients with mitral ste nosis. To evaluate the effect of percutaneous transseptal mitral valvu loplasty (PTMV) on SEC, we performed transesophageal echocardiography 1 day before and 3 months after PTMV on 88 consecutive patients. SEC w as present in 65 (74%) patients before PTMV and was associated with ab sence of moderate or severe mitral regurgitation (p = 0.01), a smaller valve area (p = 0.02), an older age (p = 0.04), and atrial fibrillati on (p = 0.05). At 3 months, PTMV resulted in a mean absolute and relat ive increase in valve area of 0.54 +/- 0.36 cm(2) and 53% +/- 43%, res pectively. SEC resolved in 37 patients but persisted in 28 (32%) patie nts at the 3-month study. The absolute and relative increase of valve area and worsened mitral regurgitation after PTMV were predictors of r esolution,of SEC, with the relative increase in valve area being the o nly significant predictor on multivariate analysis. PTMV frequently re sults in resolution of SEC, which may have important implications in r educing the thromboembolic risk in these patients.