RHEUMATIC MITRAL STENOSIS WITH LEFT ATRIAL APPENDAGE THROMBUS - EFFECT OF ORAL ANTICOAGULATION ON LEFT ATRIAL APPENDAGE THROMBUS RESOLUTION

Volume : VII, Issue : VII, July - 2018

Elangovan. C, Rajasekhar Ramesh D. Prathap Kumar Gorijavaram, Swaminathan. N, Gnanavelu. G, Ravishankar G

Aim: Rheumatic heart disease is one of the commonest cardiac condition in India in both children and adults. Left atrial (LA)

thrombus formation remains a significant problem causing morbidity and mortality in rheumatic mitral stenosis. This study is

aimed to study the effect of oral anticoagulation on resolution of left atrial appendage thrombus.

Methods: Thirty patients with severe mitral stenosis who showed evidence of left atrial appendage thrombus by

transoesophageal echocardiography and who gave consent for the study were selected for the study. Five patients who lost

follow–up were excluded from the study.The dose of Acitrom needed ranged between 2 to 4 mg / daily, and all patients were

maintained with INR 2 to 3 over a mean period of 6 weeks.

Results: This study involved twenty–five patients (16– female; 9– male) aged between 22 to 44 years (Mean 32.2 +_6.4 years).All

the patients had severe mitral stenosis with mean mitral valve area by pressure half time method was 0.62 +_0.11 sq.cm and

mean and peak gradient 15.4+_1.95 and 24.65 +_2.98 mm Hg.LA appendage was dilated in all patients with maximum area by

planimetry method ranged between 3.8 cm 2 to 7.35 cm 2, mean+_ SD (5.32 +_0.77 cm2).LA appendage thrombus was present

in all patients. Their major and minor dimensions ranged between 1.2x1.1 cm to 4.7 x 2.1 cm.The dose of Acitrom needed ranged

between 2 to 4 mg / daily, and all patients were maintained with INR 2 to 3 over a mean period of 6 weeks.Focussed TEE done at

6th week showed complete resolution of LA appendage thrombus resolved in four patients and more than 30% reduction in size

of thrombus in four patients. In the remaining 17 patients there were no significant changes in the size of the thrombus. None of

the patients showed significant increase in size of the thrombus. Repeat objective reassessment of left atrial spontaneous echocontrast

was done. None of the patients showed any notable change in grade of LASEC.