Ayesha Bajwa, Syed Najam Hyder, Zaba Aziz.
Echocardiographic predictors of left atrial thrombus formation in patients with rheumatic mitral stenosis.
Pak Heart J Jan ;49(3):117-20.

Objective: To assess the factors responsible for left atrial appendage clot formation in patients with severe mitral stenosis employing trans-esophageal echocardiography. Methodology: An observational cross sectional study was conducted on patients with severe mitral stenosis who underwent transesophageal echocardiography before percutaneous transmitral commisurotomy from 1st August to 1st December 2015. Patients were divided into two groups on the basis of presence or absence of thrombus. Group -1 Patients with thrombus while Group-2 patients included those without thrombus in left atria. Data were entered in the SPSS-20 and echocardiographic factors responsible for clot formation were analyzed. Results: Out of 82 patients, 73 of patients were women. Mean age was 35.87+-11.8 years. Group 1 included 24 patients (women to men ratio 91:9).Group 2 included 58 patients(women to men ratio 88:12). Patients of both groups did not differ significantly regarding age, sex, systolic pulmonary artery pressure and mitral valve mean pressure gradient (MVMPG) but group 2 patients had less frequent atrial fibrillation (p 0.05), smaller left atrial size (p 0.05), bigger mitral valve area and no low flow velocities (p 0.05) which indicated left atrial appendage dysfunction. Atrial fibrillation was observed in 35(42.7%) patients and was significantly associated with thrombus formation i.e. 20(83.3%)patients. Conclusion: It is concluded that frequency of left atrial thrombus formation is increased in patients of rheumatic mitral stenosis with low left atrial appendage flow velocities, atrial fibrillation and smaller mitral valve area. K

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