Transesophageal Echocardiography During Percuta- neous Mitral Commissurotomy in Patients with Left Atrial Thrombus
SUDARATANA TANSUPHASWADIKUL, M.D.*, KRIENGKRAI HENGRUSSAMEE, M.D.*, THAMARATH CHANTADANSUWAN, M.D.*, SONGKWAN SILARUKS, M.D.**, WIRASH KEHASUKCHAROEN, M.D.*, BOONJONG SAEJUENG, M.D.*
Affiliation : * Cardiology Unit, Central chest Hospital, Nonthaburi 11000, ** Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Background : Transesophageal echocardiography (TEE) is used routinely before percuta-
neous transvenous mitral commissurotomy (PTMC) to detect left atrial appendage thrombus (LAAT)
to avoid the risk of embolic complications. The issue of whether patients with small and fixed LAAT
should be denied the potential benefit of PTMC is worth examining.
Objective : To evaluate the safety and efficacy of PTMC with Inoue balloon catheter in
mitral stenosis patients with LAA T using TEE continuous monitoring during the procedure.
Materials and Methods : All TEE studies performed during PTMC and transthoracic echo-
cardiography (TTE) performed the same day and repeated on the day after the procedure between
March 1995 and January 2000 were reviewed.
Results : A total of 1,238 consecutive TEE during PTMC were reviewed. LAAT was
detected in Ill patients (mean age 43.7 ± 10.1 years, male : female = 1 : 2, atrial fibrillation : sinus
rhythm 2.47 : 1). LAAT were grossly oval with the largest measuring 3.5 x 2.8 centimeters. Mobile
LAA T was detected in 3 patients (2. 7% ), one of whom developed a transient ischemic attack and
another had an episode of stroke after PTMC. Mitral valve area (by 2D Echocardiography) pre
PTMC was 0.8 ± 0.2 cm2 and post-PTMC was 1.5 ± 0.3 cm2• Most of our patients became fully
ambulatory and could be discharged from the hospital the day after the procedure, except for two
patients who developed severe mitral regurgitation and needed elective mitral valve surgery there-
after.
Conclusion : PTMC with the Inoue-balloon catheter can be carefully and safely performed
in patients with small, fixed LAA T under 'continuous TEE guidance with acceptable risk.
Keywords : Mitral Stenosis, Percutaneous Transvenous Mitral Commissurotomy, Left Atrial Thrombus
