Resolution of Left Atrial Appendage Thrombi with Anticoagulant Therapy in Candidates for Percutaneous Mitral Commissurotomy

Abstract

Fate of left atrial thrombi (LAT) among candidates of Percutaneous Mitral Commissurotomy (PTMC) after oral anticoagulant therapy is not well documented. The aim of the study was to estimate the resolution rate of documented LAT and its predictors. In this prospective cohort study all consecutive patients with tight mitral valve stenosis and valve morphology suitable for PTMC on transthoracic ocardiography complicated by atrial fibrillation and LAT on Transoesophageal echocardiography (TEE), were followed between Jan 1998 and June 2002. Patients with multiple thrombi in LA cavity and very large and organized thrombi were excluded and referred for surgical intervention. All other patients received oral anticoagulation (INR 2-3). Serial TEE were performed at third and seventh months to observe the resolution of LAT. During study period a total of 42 patients were followed for 3- 7 months. LAT was totally dissolved in 32 patients with overall resolution rate of 76 %. Patients with resolved LAT underwent uneventful PTMC. The median period of resolution was 22 weeks. Significant predictors of LAT resolution were the size of LAT and severity of left atrial spontaneous echo contrast. Patients with pliable mitral stenosis complicated by atrial fibrillation and small LAT should be given a trial of OA therapy. Such patients can safely undergo  PTMC on resolution of LAT.