Early Assessment of Left Atrial Appendicular Velocities in Patients Undergoing Balloon Mitral Valvuloplasty

Abstract

Introduction: Peripheral embolism is a major complication in patients with mitral stenosis. Several studies have suggested a relation between a decrease in left atrial appendage (LAA) function and more frequent thromboembolic events of cardiac origin. This study was conducted to assess LAA function before and after percutaneous transvenous mitral commissurotomy (PTMC) using transesophageal echocardiography and to determine factors related to improvement in LAA function. Methods: Fifty consecutively admitted patients with significant mitral stenosis undergoing PTMC were included in the study. All patients underwent transthoracic and transesophageal echocardiographic examination, including the study of LAA velocities, before and 48 h after PTMC. Results: PTMC resulted in a twofold increase in the mitral valve area and no severe mitral regurgitation occurred. The mean mitral valve orifice area increased from 0.9 ± 0.3 cm2 to 1.84 ± 0.22 cm2. There was a decrease in the mean left atrial pressure from 26 ± 8.6 to 12 ± 2.8 mmHg. PTMC also resulted in a significant improvement in the LAA flow velocities, with the anterograde component of the flow increasing from 19.56 ± 9.48 cm/s to 33.10 ± 14.01 cm/s. There was also a significant resolution of the spontaneous echo contrast in the left atrium. Conclusion: There is a significant improvement in the LAA velocities following PTMC and a significant decrease in the spontaneous echo contrast, potentially leading to a lower risk of embolism.

Keywords

• balloon mitral valvuloplasty
• left atrial appendicular velocities
• mitral valve orifice area
• percutaneous mitral commissurotomy