Effectiveness of PTMC in Mitral Stenosis after Resolution of Left Atrial Appendage Thrombosis by Oral Anticoagulant.


  • ananda GC Department of Cardiology, Chitwan Medical College, Bharatpur, Nepal Author




Balloon Valvuloplasty, LA Thrombus, Anticoagulant


Background and Aims: Open Surgical Commissurotomy is considered as the only treatment option in presence of a thrombus that contraindicates PTMC. However, this study was designed to see the effectiveness of PTMC after resolution of Left Atrial (LA) Appendage thrombus by anticoagulant (Warfarin and Rivaroxaban ) for 3-6 months .

Methods: It is a prospective observational study of total 12 patients with Rheumatic Mitral Stenosis with LA Appendage thrombus. Out of them, 8 patients underwent PTMC after resolution of thrombus at Cath lab under Department of Cardiology of Chitwan Medical College from July 2019 to March 2020. PA pressure, LA pressure and Aortic pressure were assessed by right heart catheterization by using multipurpose /pigtail catheter whereas mitral valve area and mean mitral valve gradient were assessed by TTE.

Result: Among 12 patients with LA appendage thrombus, 8 patients (66.67%) underwent successful PTMC after complete resolution of thrombus. After the procedure, the mean mitral valve area and mean aortic pressure increased from 0.83±0.2 cm2 to 1.63±0.18 cm2 and from 99.50 ±7.93 mmHg  to  106.13±12.25 mmHg respectively. Whereas, mean pressure gradient decreased from 15.88± 4.42 mmHg to 7.13±2.10 mmHg, mean pulmonary artery pressure decreased from 44.13 ±20.85 mmHg to 33.25±19.40 mmHg and mean left atrial pressure decreased from 26.13±6.31 mmHg to 17.38±6.12 mmHg.

Conclusion: This study showed that PTMC in mitral stenosis was successful in those patients whose LA appendage thrombus was resolved by giving oral anticoagulant for 3-6 months without significant MR and tachycardia.


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Silaruks S, Thinkhamrop B, Kiatchoosakun S, Wongvipaporn C, Tatsanavivat P. Resolution of left atrial thrombus after 6 months of anticoagulation in candidates for percutaneous transvenous mitral commissurotomy. Ann Intern Med. 2004 Jan 20;140(2):101-5.

Pytlewski G, Panidis IP, Combs W, McDonough MT. Resolution of left atrial thrombus with warfarin by transesophageal echocardiography before percutaneous commissurotomy in mitral stenosis. Am Heart J. 1994 Oct;128(4):843-5.

Deverall PB, Olley PM, Smith DR, Watson DA, Whitaker W. Incidence of systemic embolism before and after mitral valvotomy. Thorax. 1968 Sep;23(5):530-6.

Rowe JC, Bland EF, Sprague HB, White PD. The course of mitral stenosis without surgery: ten- and twenty-year perspectives. Ann Intern Med. 1960 Apr;52:741-9.

Srimannarayana J, Varma RS, Satheesh S, Anilkumar R, Balachander J. Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: a transesophageal echocardiographic study. Indian Heart J. 2003 Jul-Aug;55(4):358-61.

Hwang JJ, Kuan P, Tzou SS, Fuh MC, Cheng JJ, Lien WP. Resolution of left atrial thrombi after anticoagulant therapy in patients with rheumatic mitral stenosis: report of four cases. J Formos Med Assoc. 1993 Jan;92(1):72-7.






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