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PubMed1998

Assessment of Left Atrial Appendage Structure and Function by Transesophageal Echocardiography: A Review.

This article examines the transesophageal echocardiographic assessment of the left atrial appendage anatomy and function in individuals without significant structural heart disease and in those with atrial fibrillation with or without cardioembolism or mitral valve stenosis. We also summarize the available data in the usefulness of transesophageal echocardiographic studies in patients undergoing cardioversion for atrial fibrillation and percutaneous balloon valvuloplasty for mitral stenosis. Also, potential limitations and ongoing developments in the use of transesophageal echocardiography in the assessment of the left atrial appendage are outlined, and recommendations are given for the uniform reporting of quantitative data.

Journal Article↗
PubMed1992

Features of patients with severe mitral stenosis with respect to atrial rhythm. Atrial fibrillation in predominant and tight mitral stenosis.

The aim of this study was to assess the features of patients with severe mitral stenosis in relation to atrial rhythm. Six hundred and fifty patients (pts) with severe mitral stenosis (MS) (valve area less than or equal to 1.5 cm2) who underwent percutaneous balloon commissurotomy (n = 600) or surgery (n = 50) were classified into 3 groups according to their atrial rhythm (AR): group A: sinus rhythm (SR) (n = 379), group B: SR with episodes of transient atrial fibrillation (AF) (n = 65), group C: permanent AF (n = 206). Uni- and multivariate analysis of clinical, echocardiographic and hemodynamic parameters with respect to the atrial rhythm was performed. Some parameters were comparable in all 3 groups: sex, pulmonary, right and left atrial pressures, mitral valve area, incidence of associated aortic valve disease. Nine parameters were different: mean age, NYHA class III or IV, previous commissurotomy, previous embolism, cardiac index, mitral regurgitation, tricuspid regurgitation, left atrium diameter, mitral calcification. Multivariate analysis, identified age, left atrial diameter and presence of mitral calcification as independent predictors of atrial fibrillation. Transoesophageal echocardiography was performed in 167 cases. A spontaneous echo contrast was recorded in 106 cases (63.5%) and was significantly correlated with a history of embolism and or left atrial thrombi detected by echocardiography. Atrial fibrillation, size of left atrium, severity of mitral stenosis and cardiac index were found to be independent predictive factors of spontaneous echo contrast.

Adult↗
PubMed1986

Two-dimensional echocardiographic evaluation of the severity of mitral stenosis with reference to the prediction for mitral valve commissurotomy or replacement.

Thirty patients with mitral stenosis were classified into three grades of severity reflected by anterior mitral leaflet and subvalvular apparatus using two-dimensional echocardiography in order to study the possibility of predicting the type of surgery indicated, and were evaluated pre- and postoperatively for systolic and diastolic volumes; left heart function using left ventricular posterior wall movement (LVPWVSmax, LVPWVdmax) and posterior wall excursion (PWE) and newly devised left atrial empty volume ratio (LAEVR). The LVPWVSmax was increased from 57 +/- 7 to 74 +/- 7 mm/s (p less than 0.001) in grade I, from 48 +/- 13 to 63 +/- 9 mm/s (p less than 0.02) in grade II, and from 44 +/- 6 to 64 +/- 7 mm/s (p less than 0.001) in grade III. The LVPWVdmax showed an increase from 68 +/- 15 to 91 +/- 15 mm/s (p less than 0.001) in grade I, from 57 +/- 17 to 86 +/- 18 mm/s (p less than 0.01) in grade II, and from 55 +/- 11 to 83 +/- 6 mm/s (p less than 0.01) in grade III. In the PWE, there was an improvement from 12.4 +/- 1.6 to 15.5 +/- 2.1 mm (p less than 0.01) in grade I; from 10.5 +/- 2.0 to 12.5 +/- 1.5 mm (p less than 0.02) in grade II; and from 9.4 +/- 1.5 to 14.4 +/- 1.5 mm (p less than 0.001) in grade III. In the LAEVR, there was also an improvement from 65 +/- 12 to 39 +/- 21% (p less than 0.01) in grade I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗