Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations

Hwang, Juey-Jen; Chen, Jin-Jer; Lin, Song; Tseng, Yung Zu; Kuan, Peiliang; Lien, Wan‐Ching; Lin, Fang‐Yue; Chu, Shu‐Hsun; Hung, Chi‐Ren; How, Shu-Wen

doi:10.1016/0002-9149(93)90884-f

Cited by 105 publications

(16 citation statements)

References 19 publications

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“…Atrial thrombus formation following conversion to a normal sinus rhythm can be best viewed via transesophageal echocardiography, which yields a 93% sensitivity and 100% specificity for thrombus detection [4]. The largest risk for postablation thrombus formation occurs after manipulation in the left atrial cavity during which clot formation may occur in the endocardium of the left atrium [5].…”

Section: Discussionmentioning

confidence: 99%

A Stunning Left Atrial Appendage Thrombus

Ali

Ugwu²,

Kanjwal³

2016

Cardiology

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Background: Left atrial appendage thrombus formation is a known major complication of atrial fibrillation and atrial flutter which increases the risk of embolism and stroke. This risk of thrombosis is greatly increased with a lack of anticoagulation. After conversion to a normal sinus rhythm in these arrhythmias, the risk of thrombus formation in the left atrium persists through a phenomenon termed atrial myocardial stunning. Case: We present the case of a patient who previously underwent successful pulmonary vein isolation and was found to be in typical isthmus-dependent atrial flutter with a questionable recurrence of atrial fibrillation. The decision was made to return for atrial flutter ablation and for evaluation of prior pulmonary vein isolation. Initially, a transesophageal echocardiogram showed a normal ejection fraction, biatrial enlargement and no left atrial appendage thrombus. Ablation of the cavotricuspid isthmus was successfully accomplished with documented bidirectional block. A transesophageal echocardiogram probe was still in place prior to planned transseptal puncture for the evaluation of pulmonary veins. A large thrombus was now observed filling the left atrial appendage. Conclusion and Objective: Atrial stunning is a transient atrial contractile dysfunction that occurs whether sinus rhythm is restored spontaneously, electrically, pharmacologically or by ablation. We know after conversion that there is higher propensity to increased spontaneous echogenic contrast and decreased velocities; however, we do not have documented knowledge of exactly how soon after the conversion to a sinus rhythm a thrombus may be seen. We demonstrate a case of acute left atrial appendage thrombus formation immediately following the successful ablation of isthmus-dependent atrial flutter. Our report validates the belief that strategies of not interrupting anticoagulation prior to the conversion of these arrhythmias should be implemented.

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Section: Discussionmentioning

confidence: 99%

A Stunning Left Atrial Appendage Thrombus

Ali

Ugwu²,

Kanjwal³

2016

Cardiology

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“…Detection of such thrombi by transthoracic or trans-esophageal echocardiography is very specific (99%) [1] and important as they are potential sources of thromboemboli. In fact, the treatment is based on heparin treatment associated with aspirin for at least 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

A Neovascularized Left Atrial Mass

Hammami

Abid

Mallek

et al. 2012

Case Reports in Medicine

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Background. The discovery of a large left atrial mass through echocardiography obliges the clinician to perform a differential diagnosis to distinguish tumor from thrombus. The neovascularization of the mass could be helpful to predict the type of the malformation and whether it is in favour of a vacular tumour rather than a thrombus . Observation. A 43-years-old man who had no cardiac antecedent reported that he have had dyspnea and palpitation since 10 months. The cardiac auscultation, revealed an irregular rhythm with diastolic murmur at the apex. The electrocardiogram showed an atrial fibrillation. The transthoracic echocardiography revealed a severe mitral stenosis with a huge left atrial mass, confirmed through transesophageal echocardiography. After 4 weeks of an efficient anticoagulant treatment, the mass was still persistent in the echocardiography. So we decided to resect the mass and to achieve a mitral valve replacement. The preoperative coronarography showed neovascularization among the mass and fistula from the circumflex artery. Considering the characteristic of the mass (neovascularization and resistance to anticoagulant), we strongly suspected a vascular tumor especially myxoma, but the histological exam revealed an organized thrombus. Conclusion. Coronary neovascularization is a specific sign for left atrial thrombus in mitral stenosis, but surgery is the best way to confirm diagnosis.

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“…There was no comment about the thrombus in the LA and the LAA on the pre-operative TTE examination; it is difficult to observe a LAA by TTE, so the sensitivity of the TTE of the LA or LAA is known as 39-63% [5,6]. In contrast, by TEE, observing the posterior structures of the heart, such as the LA and LAA is much easier, the sensitivity and the specificity of thrombus in the LA was reported as 93-100% and 99-100%, respectively [5,6].…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage thrombus detected by intraoperative transesophageal echocardiography in a patient with acute small bowel infarction -A case report-

Kang

Choi

Kim

et al. 2010

Korean J Anesthesiol

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Acute mesenteric ischemia and infarction is an emergent situation associated with high mortality, commonly due to emboli or thrombosis of the mesenteric arteries. Embolism to the mesenteric arteries is most frequently due to a dislodged thrombus from the left atrium, left ventricle, or cardiac valves. We report a case of 70-year-old female patient with an acute small bowel infarction due to a mesenteric artery embolism dislodged from a left atrial appendage detected by intraoperative transesophageal echocardiography and followed by anticoagulation therapy.

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Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations

Cited by 105 publications

References 19 publications

A Stunning Left Atrial Appendage Thrombus

A Stunning Left Atrial Appendage Thrombus

A Neovascularized Left Atrial Mass

Left atrial appendage thrombus detected by intraoperative transesophageal echocardiography in a patient with acute small bowel infarction -A case report-

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