Left atrial thrombus detection with multiplane transesophageal echocardiography: An echocardiographic study with surgical verification

Background and aim of the study: The detection of left atrial thrombus (LAT ) is especially important in patients being evaluated for percutaneous mitr al valvuloplasty and elective cardioversion for atrial fibrillation. Transe sophageal echocardiography (TEE) is widely used for this indication. This s tudy was undertaken to validate the use of multiplane TEE to detect LAT in the setting of rheumatic mitral valve disease. Methods: The study population comprised 262 patients (103 men, 159 women, m ean age 42.2 +/- 13.1 years) who underwent open heart surgery for rheumatic mitral valvular disease between January 1994 and October 1997. Of these pa tients, 178 had mitral stenosis and 84 mitral regurgitation. All patients w ere examined with multiplane TEE less than three days before valvular surge ry. Results: The presence or absence of LAT was confirmed at surgery by direct inspection of the left atrium. Left atrial thrombi were detected by TEE in 34 patients (14 men, 20 women; mean age 51 +/- 8 years). The presence of al l 34 thrombi found by multiplane TEE was confirmed during surgery. Only one thrombus was confirmed surgically among 228 patients shown thrombus-negati ve by multiplane TEE. The sensitivity, specificity, positive and negative p redictive value and diagnostic accuracy for multiplane TEE were 97, 100, 10 0, 99.6 and 99.6%, respectively. Conclusions: Multiplane TEE is exquisitely sensitive for the detection of L AT.