Thromboembolic Complications of Mitral Valve Disease

Abstract

Summary: Five hundred and eighty‐eight patients with mitral valve disease were studied. The incidence of systemic emboli was found to be higher in patients with pure mitral stenosis (16‐6%) and mixed mitral stenosis and incompetence (19‐4%) than in patients with mitral incompetence (3‐1%). The patients with mitral stenosis who had episodes of systemic emboli tended to be older than 40 years, with moderate or severe valve lesions, atrial fibrillation and moderate or gross enlargement of the left atrial appendage or left atrium. The following factors were found to be unrelated to systemic embolism–associated aortic valve disease, sex, smoking habit, history of rheumatism, parity, haemoglobin, blood urea, pulmonary hypertension, duration of antifailure treatment, presence of heart failure, and cardiothoracic ratio.

Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty

“…After PMBV this sP-selectin shows a progessive decline, which is (1)(2)(3)(4). Although anticoagulation therapy is certainly indicated in these patients, need for anticoagulation therapy is under debate for patients in sinus rhythm (19).…”

“…Previous studies demonstrate that patients with mitral stenosis (MS), particularly those with atrial fibrillation (AF), are at increased risk of developing left atrial thrombus and the associated thromboembolic complications (1)(2)(3)(4). AF itself has been shown to be associated with a hyercoagulable state, with abnormalities of hemostasis, platelets, and endothelial dysfunction (5,6), however, coagulation activity is also increased in mitral stenosis per se (7).…”

Left atrial appendage: structure, function, and role in thromboembolism

“…However, LAA size determined at surgery has been related to the occurrence of embolic events41 and studies with transoesophageal echocardiography have shown that thrombus and subsequent thromboembolic events are clearly related to LAA size. An enlarged left atrium on transoesophageal echocardiography is associated with an enlarged LAA in 59% of patients; conversely, a normal sized left atrium is associated with an enlarged LAA in 15% of patients.…”

Caso 1/2007: enterorragia e choque em mulher de 69 anos portadora de estenose mitral reumática com fibrilação atrial crônica

“…Antes do advento da terapia com anticoagulantes, 25% dos óbitos em pacientes com estenose mitral estavam relacionados a embolizações sistêmicas 4,5 . Ainda mais, a associação entre estenose mitral e fibrilação atrial confere um risco de embolização sistêmica entre 4% e 6% ao ano.…”