A STUDY OF SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH RHEUMATIC MITRAL-STENOSIS AND NORMAL SINUS RHYTHM - AN INDIAN PERSPECTIVE

Objective-To study the incidence of spontaneous echo contrast in left atrium of Indian patients with rheumatic mitral stenosis in normal sin us rhythm and to define its relations. Subjects-Transthoracic and mult iplane transoesophageal echocardiographic studies were performed in 89 consecutive patients with rheumatic mitral stenosis who were in norma l sinus rhythm. Results-Spontaneous echo contrast in the left atrium w as seen in 57.3% of patients on multiplane transoesophageal echocardio graphy and in only 5.6% on transthoracic echocardiography. The mean mi tral valve area was 1.07 (SD 0.33) cm(2) and 1.32 (0.45) cm(2) (P = 0. 004), mean left atrial size was 4.27 (0.67) cm and 3.91 (0.5) cm (P = 0.029), mean diastolic pressure gradient was 12.64 (5.69) mm Hg and 10 (5.5) mm Hg (P = 0.049), and absence of mitral regurgitation was seen in 45% and 23% of patients respectively (P = 0.1). Among patients wit h spontaneous echo contrast, 31% had either left atrial/appendage thro mbus or a history of embolism, v 0% in patients embolism. without spon taneous echo contrast (P < 0.0001). Conclusions-There is a high incide nce of spontaneous echo contrast in the left PATIENTS atrium in Indian patients with rheumatic mitral stenosis in normal sinus rhythm on mul tiplane transoesophageal echocardiography. These patients are likely t o embolise or form thrombi in the left atrium. The presence of spontan eous echo contrast is also associated with significantly smaller mitra l valve area, larger left atrium, and higher mean diastolic mitral pre ssure gradient.