A left atrial thrombus is not an absolute limitation to balloon mitral commissurotomy for patients with mitral stenosis - A serial transesophageal echocardiographic study

Previous reports did not encourage balloon mitral commissurotomy (BMC) when left atrial (LA) thrombi were located beyond LA appendage. We hypothesize that LA thrombi may be resolved in some patients after anticoagulant therap y, and BMC can be performed subsequently. In the present study, we used tra nsesophageal echocardiography (TEE) to evaluate the effects of anticoagulan t on LA thrombi in patients with mitral stenosis, to compare the clinical d ifferences between patients with (group A) and without (group B) resolution of LA thrombi, and to evaluate the safety of subsequent BMC in these patie nts. TEE was performed on 190 consecutive patients with mitral stenosis; 14 (7.4%) of them were found with LA thrombi. Serial TEE was performed and op timal anticoagulant therapy was achieved in all 14 patients. The thrombi we re located within the LA appendage in 6 cases, attached to the LA posterior wall in 5, posterior wall and interatrial septum in 1, and LA appendage an d posterior wall in 2. Based on the 6-month TEE follow-up, we found that th e LA thrombi disappeared in 8 (57.2%) patients (group A) and persisted in 5 patients (group B). LA thrombi resolved within 3 months in 7 group A patie nts (87.5%). Furthermore, the resolution of LA thrombi was more frequently observed in patients either with a smaller LA dimension (51.9 +/- 3.4 vs. 5 7.8 +/- 4.8 mm, p = 0.02) or with their thrombi located inside their LA app endage (p = 0.03). No differences in other clinical and echocardiographic v ariables were noted between these two groups. Subsequently, group A patient s underwent BMC without complications of systemic embolization. In conclusi on, LA thrombi can be resolved after optimal anticoagulant therapy in a con siderable proportion of patients with mitral stenosis. Serial TEE studies a re helpful to observe LA thrombus resolution; they may also be useful in pl anning the treatment strategy. Copyright (C) 2000 S. Karger AG. Basel.