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Abstract
This study included 25 patients (15 males, 10 females, and age 15: 35 years) with rheumatic mitral stenosis and sinus rhythm.
All patients were subjected to:
1. Clinical examination.
2. 12 lead surface ECG to exclude AF.
3. Transthoracic echocardiography (TTE) before and after PBMV for calculation of MVA and detect MR if present and it is degree and assesment of subvalvular apparatus.
4. Transesophageal echocardiography (TEE) before and after PBMV.
All patients were examined by TEE before PBMV by one week to exclude left atrial and left atrial appendage (LAA) thrombus and to asses the function of LAA as follow :
-LAA appendage EF% by planimetry method.
-LAA peak flow velocities (antegrade and retrograde).
After percutaneous balloon mitral valvuloplasty the patients were examined by TTE to calculate MVA and detect MR if present and it is degree.
The procedure was consider successful when MVA increased >1.5 cm or double the pre-procedural area.
The patients with successful procedure were submitted to TEE within 4 weeks for evaluation of LAA function and compare it with pre- procedural function.
We have found that LAA EF% increased from 26.412 ± 5.601 (%) before PBMV to 38.584 ± 5.804 (%) after the procedure.
LAA filling velocities or antegrade (A wave) increased from
27.592 ± 7.843 (cm/s) to 40.380 ± 10.993 (cm/s) after the procedure.
LAA emptying velocities or retrograde (R wave) increased as well from 33.564 ± 10.432 (cm/s) to 45.312 ± 14.971 (cm/s) after PBMV
Thus improvement of the left atrial appendage function was induced by the relief of the left atrial hypertension after successful percutaneous ballon mitral valvuloplasty in patients with mitral stenosis and sinus rhythm.
So we recommend the use of anticoagulant for all patients with tight mitral stenosis and sinus rhythm for protection against LAA thrombus formation and thromboembolic manifestation .