Reappraisal by transesophageal echocardiography of the significance of left atrial thrombi in the prediction of systemic arterial embolization in rheumatic mitral valve disease

Juey Jen Hwang, Peiliang Kuan, Shen Chang Lin, Wei Jan Chen, Meng Huan Lei, Yu Lin Ko, Jun Jack Cheng, Jiunn Lee Lin, Jin Jer Chen, Wen Pin Lien

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Systemic arterial embolization imparts a significant risk of serious complications throughout the lives of patients with rheumatic heart disease. Left atrial (LA) thrombi have been thought to be the major source of emboli. A transesophageal echocardiography (TEE) study of 260 consecutive patients with rheumatic mitral valve disease was performed during a period of 24 months, with particular reference to understanding the association between LA thrombi and embolic complications. Of these patients, 155 had predominant mitral stenosis, 24 had significant mitral regurgitation, and the remaining 81 with xenograft mitral valve replacement developed valvular dysfunction (25 resulted in predominant mitral stenosis and 56 in significant mitral regurgitation). LA thrombi were detected in 38 patients (group A) and absent in 222 (group B). Group A patients had a higher frequency of recent (≤1 week before TEE study) and remote (>1 week before) embolization than did group B patients (recent: 26.3 vs 5.4% [p < 0.001]; remote: 18.4 vs 5.0% [p < 0.01]). The frequency of atrial fibrillation was also greater in group A patients (100 vs 74.3%; p < 0.001). The exclusion of patients with significant mitral regurgitation and sinus rhythm had no effect on the association between LA thrombi and evidence of previous embolization. It is concluded that TEE is a convenient diagnostic modality that can be used to identify a subset of patients with rheumatic mitral valve disease at high risk for systemic embolization. Consequently, preventive anticoagulation for possible embolic complications should be more vigorously adhered to in patients with rheumatic mitral valve disease and LA thrombi.

Original languageEnglish
Pages (from-to)769-773
Number of pages5
JournalThe American Journal of Cardiology
Issue number7
Publication statusPublished - Sep 15 1992
Externally publishedYes


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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