COMPARATIVE-EVALUATION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN DETECTION OF LEFT ATRIAL THROMBUS BEFORE PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY - DO ALL PATIENTS NEED TRANSESOPHAGEAL EXAMINATION

We postulated that the sensitivity of transthoracic echocardiography i n detection of left atrial cavity or appendage thrombi is better in so uth-east asian patients with rheumatic mitral stenosis. This was consi dering that these patients are generally younger, have lesser body wei ght and thinner chest walls resulting in better transthoracic echogene city than their western counterparts. We prospectively performed trans thoracic and transoesophageal echocardiography in 150 consecutive Indi an patients (mean age 28.8+/-7.2 years; 78 men) being evaluated for pe rcutaneous transvenous mitral commissurotomy. The overall sensitivity of transthoracic echocardiography was 74% (95% C.I. 59-88%). This was significantly higher than the pooled estimate from five western report s which evaluated similar patients (overall sensitivity 12%; 95% C.I. 0-25%; P<0.0001). The sensitivity rose to 83% when patients with poor echogenecity were excluded. Amongst patients with good echogenecity (8 1% patients) the diagnosis of left atrial thrombi was correctly made o r suspected on transthoracic examination in all patients subsequently shown to have thrombi on transoesophageal echocardiography. Significan t savings in cost may be safely achieved by limiting transoesophageal echocardiography to patients in whom left atrial cavity or appendage i s not adequately visualized on transthoracic examination due to poor e chogenecity, or in whom there are shadows suggestive but not diagnosti c of thrombi. (C) 1997 Elsevier Science Ireland Ltd.