Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty

Abstract

Left atrial thrombi are common in patients with mitral stenosis. When percutaneous balloon mitral valvuloplasty is performed on such patients, there is a potential risk of thrombus dislodgment and embolization. In this study conventional transthoracic echocardiography and transesophageal echocardiography were performed for percutaneous balloon mitral valvuloplasty on 19 consecutive candidates (6 men, 13 women, 23 to 81 years old). In five patients (26%), transesophageal echocardiography revealed a left atrial thrombus; in only one of these was there a suspicion of left atrial thrombus on transthoracic echocardiography. Balloon mitral valvuloplasty was canceled in four of the five patients. Three underwent mitral valve surgery that confirmed the echocardiographic findings. Transesophageal echocardiography is better than conventional transthoracic echocardiography in detecting left atrial clots in candidates for balloon mitral valvuloplasty. Because of the potential risk of embolization, transesophageal echocardiography is recommended in all candidates for balloon mitral valvuloplasty.

Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy

“…Some studies have compared the relative merits of TTE and TOE in the assessment of patients undergoing BMV. Left atrial thrombus cannot be reliably excluded by TTE because of its inability to visualise the left atrial appendage fully in all patients, [14][15][16] and many centres now routinely perform TOE before BMV for this reason. The longitudinal transgastric plane, when available, also allows more detailed visualisation of the chordae and papillary muscles than does TTE.…”

Development of left atrial thrombus following attempted percutaneous mitral valvuloplasty

“…These cases, particularly case B, illustrate the utility of intraprocedural transesophageal echocardiography before, during, and after percutaneous mitral valvuloplasty [3,4]. The TEE procedure is usually well tolerated.…”

Assessment of Mitral Valve Disease: A Review of Imaging Modalities

“…TEE is also recommended in pre-operative planning for MV surgery or in patients being considered for PMBC for two reasons. First, compared to TTE, it has greater sensitivity for detection of LA or LA appendage clot, which must be excluded given the potential risk of peri-procedural embolization with PMBC [74]. Second, TEE provides better assessment and quantification of MR, which is important because significant MR is generally a contraindication to PMBC.…”