Rheumatic Mitral Stenosis with Left Atrial Appendage Thrombus - Effect of Oral Anticoagulation on Left Atrial Appendage Thrombus Resolution.

Elangovan, C (2006) Rheumatic Mitral Stenosis with Left Atrial Appendage Thrombus - Effect of Oral Anticoagulation on Left Atrial Appendage Thrombus Resolution. Masters thesis, Madras Medical College, Chennai.

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Abstract

Rheumatic heart disease is one of the commonest cardiac condition in India in both children and adults, accounting for 30- 40 % of cardiac cases admitted in hospital. Approximately 25% of all patients with rheumatic heart disease have pure or predominant mitral stenosis (MS). Thromboembolism develops in at least 20% of mitral stenosis patients, at some point of time during the course of their disease. Thromboembolism remains an important cause of morbidity and mortality in rheumatic MS. Cardiogenic embolism in mitral stenosis is most often due to left atrial (LA) thrombi and at times due to mitral valve vegetation. Left atrial appendage (LAA) is the commonest site from where the thrombus originates. Echocardiography is the widely used method for detecting left atrial and left atrial appendage thrombi. Transthoracic echocardiography (TTE) is only 50% sensitive in detecting LA and LAA thrombi. Transesophageal echocardiography (TEE) is superior to TTE and is 99% sensitive and specific in detecting LA and LAA thrombi. Left atrial spontaneous echo contrast (LASEC) or “Smoke” occurs in conditions that favours stasis of blood .It is associated with an increased risk of LA thrombus formation and arterial embolization and is better identified by TEE. Medical treatment for LA and LAA thrombus in rheumatic MS is still unclear. Several studies indicate that adequate anticoagulation using oral anticoagulants in those with atrial fibrillation and in those with documented thrombus reduce the frequency of thromboembolic phenomena. However there are not enough data whether anticoagulation resolves or reduces size of LA thrombus in patients with rheumatic MS, and thus simplifying hence simplifying surgical or interventional treatment for diseased valves otherwise suitable for closed mitral comissurotomy (CMC) or balloon mitral valvotomy (BMV). AIM OF THE STUDY: Left atrial (LA) thrombus formation remains a significant problem causing morbidity and mortality in rheumatic mitral stenosis. Medical treatment for this condition still remains unclear. This study is aimed 1. To study the effect of oral anticoagulation on resolution of left atrial appendage thrombus. 2. To analyse various factors associated with resolution or reduction in size of left atrial appendage thrombus. 3. To analyse effect of oral anticoagulation on left atrial spontaneous echo contrast. CONCLUSION: Adequate oral anticoagulation (INR 2-3) is effective in resolution of left atrial appendage thrombus in rheumatic mitral stenosis in a significant group of patients over a period of six weeks. The resolution is either complete or partial. Among patients receiving oral anticoagulation, 16% showed complete resolution of thrombus and another 16% showed more than 30% reduction in size of thrombus.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Rheumatic Mitral Stenosis ; Left Atrial Appendage Thrombus ; Oral Anticoagulation ; Left Atrial Appendage Thrombus Resolution.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 04 Jul 2017 03:47
Last Modified: 04 Jul 2017 03:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/823

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