Background and aim of the study: The detection of left atrial thrombus (LAT) is especially important in patients being evaluated for percutaneous mitral valvuloplasty and elective cardioversion for atrial fibrillation. Transesophageal echocardiography (TEE) is widely used for this indication. This study was undertaken to validate the use of multiplane TEE to detect LAT in the setting of rheumatic mitral valve disease.
Methods: The study population comprised 262 patients (103 men, 159 women, mean age 42.2+/-13.1 years) who underwent open heart surgery for rheumatic mitral valvular disease between January 1994 and October 1997. Of these patients, 178 had mitral stenosis and 84 mitral regurgitation. All patients were examined with multiplane TEE less than three days before valvular surgery.
Results: The presence or absence of LAT was confirmed at surgery by direct inspection of the left atrium. Left atrial thrombi were detected by TEE in 34 patients (14 men, 20 women; mean age 51+/-8 years). The presence of all 34 thrombi found by multiplane TEE was confirmed during surgery. Only one thrombus was confirmed surgically among 228 patients shown thrombus-negative by multiplane TEE. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for multiplane TEE were 97, 100, 100, 99.6 and 99.6%, respectively.
Conclusion: Multiplane TEE is exquisitely sensitive for the detection of LAT.