PREDICTORS OF LEFT ATRIAL THROMBUS AND SPONTANEOUS ECHO CONTRAST IN RHEUMATIC VALVE DISEASE BEFORE AND AFTER MITRAL-VALVE REPLACEMENT

In this study we aimed to analyze, with reference to mitral regurgitat ion (MR), the incidence and predictors of left atrial (LA) thrombus an d spontaneous echo contrast in patients with rheumatic valve disease b efore and after mitral valve replacement: The incidence of LA thrombus is known to be less in patients with MR. The impact of mitral valve r eplacement on this beneficial effect has not been studied in detail. T he study included 169 consecutive patients (59 men and 110 women, aver age age 40 +/- 13 years) with rheumatic mitral valve disease who under went transesophageal echocardiographic examination 1 to 3 days before and within 7 days (mean 4.0 +/- 1,3) after mitral valve replacement us ing mechanical prostheses in a single institution. The preoperative in cidence of echocardiographic LA spontaneous echo contrast (SEC) was 1. 1%, 30%, and 54%, and the incidence of thrombus was 1.1%, 13%, and 17% in the groups with MR, combined mitral stenosis + MR, and isolated mi tral stenosis, respectively, In the MR group, SEC and thrombus inciden ce increased significantly after surgery. The independent predictors f or postoperative thrombus development were atrial fibrillation, postop erative SEC, and preoperative thrombus, Thrombus recurred after surger y in 64% of 14 patients who had surgical thrombectomy. The presence of postoperative MR was associated with decreased risk of postoperative SEC and thrombus development. The interaction between MR and SEC and t hrombus both before and after surgery provides further support for the protective effect of MR against LA thrombus formation. (C)1998 by Exc erpta Medica, Inc.