Left Atrial Appendage Function in Rheumatic Mitral Stenosis and Severe Mitral Regurgitation: Transesophageal Echocardiographic Study [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 1997; 25(8): 488-493

Left Atrial Appendage Function in Rheumatic Mitral Stenosis and Severe Mitral Regurgitation: Transesophageal Echocardiographic Study

Cevat KIRMA1, Cihangir KAYMAZ1, Sibel ENAR1, Nihal ÖZDEMİR1, Bülent MUTLU1, Kenan SÖNMEZ1, Hakan DİNÇKAL1, Mehmet ÖZKAN1

Although there are several studies related to the incidence of spontaneous echo contrast (SEC) and thrombus (THR) in the left atrial appendage (LAA), between patients (pts) with rheumatic mitral stenosis (MS) and severe mitral regurgitation (MR), there is no study evaluating LAA function in these groups. To investigate LAA function in these groups, 68 pts with MS (group I, 45 F, mean age: 43 ± 14, 32 pts with sinus rhythm (SR) and 45 pts with severe MR (group II, 27 F, mean age: 45 ± 15, 28 pts with SR) and a control group (group III) including 47 pts (32 pts with SR, 15 pts with nonrheumatic atrial fibrilation [AF]) were evaluated. Transesophageal echocardiography was performed routinely in all patients, and during this procedure, in order to investigate LAA function, flow velocities and ejection fraction of LAA were measured with concomitant evaluation of incidence of SEC and THR. Left atrial appendage function and incidence of SEC and THR in the LAA were compared according to the cardiac rhythm (SR and AF). The incidence of LAA SEC formation in group I with either SR or AF was significantly higher than in the other groups (SR, AF respectively, p < .05, p < .001). The incidence of LAA THR formation in group I with AF was significantly higher than in the other groups with AF (p < .05), but in pts with SR, incidence of LAA THR w as not different between these groups (p = .06). Left atrial appendage maximal area in group I (6.58±3.7, 7.26±3.9 cm2) and group II (7 .04±3.1 , 8.2±4, 1 cm2) was larger than in the group III (356±1.9, 5.51±3.3 cm2) (SR, AF respectively p<.05). In SR, LAA flow velocities and ejection fraction in group I (0.23 ±O.11 m/sn, % 31.5 ± 14.5) was significantly lower than in group II (0.48±0.16 m/sn, % 45 ± 15.3) and group III (0.44±0.17 m/sn, % 54± 16.2), (p<.05,p<.05). In AF, similarly, LAA flow velocities and ejection fraction in group I (0.10±0.10m/sn,% 15±11.3) was signifacantly lower than in group II (0.36±0.13m/sn, % 33.6±13.7) and group III (0.28±0.1 m/sn, % 28.5±12.3), (p<.05,p<.05). No significant differences were found between pts with MR and the control group in regard to LAA function in either cardiac rhythm. Conclusion; although MS and MR share the same etiology and afflicted pts have a dilated LAA area, in pts with MS LAA function was found to be deteriorated, and thus incidence of SEC/THR was much more frequently detected in LAA. By contrast, LAA function is preserved and thus SEC/THR formation prevented in pts with MR. The disparity between pts with MS and MR groups is thought to be due to different hemodynamics influencing both left atrium and LAA.


How to cite this article
Cevat KIRMA, Cihangir KAYMAZ, Sibel ENAR, Nihal ÖZDEMİR, Bülent MUTLU, Kenan SÖNMEZ, Hakan DİNÇKAL, Mehmet ÖZKAN. Left Atrial Appendage Function in Rheumatic Mitral Stenosis and Severe Mitral Regurgitation: Transesophageal Echocardiographic Study. Turk Kardiyol Dern Ars. 1997; 25(8): 488-493
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