INTERRELATIONSHIP BETWEEN RHYTHM, LEFT ATRIAL SIZE AND THROMBUS FORMATION IN PATIENTS WITH MITRAL STENOSIS

Abstract

Objectives: To study the Interrelationship between rhythm, left atrial size and thrombus formation in patients with mitral stenosis. Methodology: This observational study was conducted in cardiology department LRH Peshawar, from February to December 2011. Every patient with severe mitral stenosis presenting for PTMC was evaluated before procedure for spontaneous echo-contrast, left atrial size, LA/LAA thrombus and its types on TTE and TEE. Baseline ECG of each patient was taken. Results: A total of 176 patients with mitral stenosis were divided into 110 patients in group I having sinus rhythm and 66 patients in group II having atrial fibrillation. In group I, 40 (36.36%) were males compare to group II having 14 (21.21%). Mean age of patient in group I was 33.13 years ± 13.82 as compared to 30.97± 8.86 years in group II. In group I, 29 (26.36%) had LA/LAA thrombus as compared to 32(48.48%) in group II on TEE(p-value=0.003). In group I, 60(54.54%) patients had spontaneous echo contrast as compared to 58(87.87%) in group II on TEE ( p-value=0.000). Mean left atrial size in group I was 4.2±0.52cm as compared to 5.3±0.71cm in group II ( p-value=0.000). In patients with AF, LA/LAA thrombus was visualized in 10 (15.15%) on TTE as compared to 32(48.48%) on TEE(p value=0.001). Conclusion: Atrial fibrillation is frequently associated with left atrial enlargement and thrombus formation in patients with mitral stenosis. The accessibility of the left atrial appendage by TEE is better than TTE in detection of thrombi.