EVALUATION OF MITRAL STENOSIS PATIENTS WITH ATRIAL FIBRILLATION FOR FACTORS ASSOCIATED WITH LEFT ATRIAL THROMBOSIS

Abstract

 

ABSTRACT
Introduction: Rheumatic heart disease still remains a common health problem and an important cause of morbidity
and mortality in all age group. Mitral stenosis is the most common cardiac valve lesion involved in rheumatic heart
disease. This can cause serious complications if left untreated and can lead to enlargement of the left atrium and stasis
of blood which increases risk of clot formation in the left atrium and the left atrial appendage. The presence of left atrial
thrombi is associated with a threefold increase in embolic events.
In clinical practice we frequently come across patients of mitral stenosis with atrial fibrillation, this study will enlighten
the practicing physicians about the magnitude of the problem of LA thrombus in patients with mitral stenosis having
atrial fibrillation and will help them to modify their management protocol accordingly to prevent the fatal complications
of Thromboembolism.
Objectives: To determine the prevalence of Left Atrial thrombus in mitral stenosis patients with atrial fibrillation. To
study the association of Left Atrial Size, gender, LASEC (Left Atrial Spontaneous Echo Contrast) and severity of Mitral
Stenosis with LA clot formation in mitral stenosis patients with atrial fibrillation.
Methods: A cross sectional descriptive type study was conducted in the Echocardiography department of the cardiology
Department Lady Reading Hospital Peshawar from March 23 , 2010 to September 22, 2010. A total of 152 consecutive
patients with severe and moderate Mitral stenosis (MS) and Atrial Fibrillation (AF) were included in this study.
12-lead Electrocardiography was done once clinical and echocardiographic features revealed moderate and severe
MS. Patients with signs of AF were selected and both Transthoracic Echocardiography (TTE) and Transesophageal
echocardiography (TEE) was performed on all patients to detect Left atrial clot.
Results: Among 152patients studied; there were 65 males and 87 females. TTE and TEE was performed in all patients
and TTE detected LA thrombus in 3 patients while TEE detected LA thrombus in 41 patients. Among them, 6 patients
had clots in LA body while LA appendage clots were found in 32 patients. Left atrial dimension was found to be relevant
(P-value = 0.004) with the presence of thrombus in patients with moderate and severe mitral stenosis associated with
atrial fibrillation. Moderate MS was present in 28(18.4%) patients while severe MS was present in 124 (81.6%)patients.
Female to male ratio was 1.6 but there was no statistically association with LA thrombus (P value=0.1363) . Left atrial
spontaneous
Authors: 
Matiullah Khan
Shahsawar Khan
Suleman Muhammad

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