Tessier P, Mercier L A, Burelle D, Bonan R
Department of Medicine, Montreal Heart Institute, Quebec, Canada.
J Am Soc Echocardiogr. 1994 Jul-Aug;7(4):394-9. doi: 10.1016/s0894-7317(14)80198-3.
To evaluate whether the presence of a left atrial appendage (LAA) thrombus increases the embolic risk of percutaneous mitral commissurotomy (PMC), we reviewed 240 transesophageal echocardiographic studies performed before intended PMC for mitral stenosis. We found 14 patients (5.8%) with left atrial clots, 12 located in the LAA (none detected by transthoracic echocardiography [TTE]) and two in the body of the left atrium. In the two patients who had a left atrial body thrombus, TTE did not unequivocally show the thrombus. Seven patients with an LAA thrombus underwent PMC by the double-balloon technique. The hemodynamic and echocardiographic results were comparable to those of the larger series. No embolic complications were noted either during the procedure, in the 48 hours of observation after the procedure, or at a mean follow-up of 12 months. We conclude that PMC by the double-balloon technique can be performed safely in patients with an LAA thrombus who have been given anticoagulants. Transesophageal echocardiography is still indicated before PMC because TTE is suboptimal for detection of left atrial clots.
为评估左心耳（LAA）血栓的存在是否会增加经皮二尖瓣交界切开术（PMC）的栓塞风险，我们回顾了240例在计划进行PMC治疗二尖瓣狭窄前进行的经食管超声心动图检查。我们发现14例（5.8%）患者存在左心房血栓，其中12例位于LAA（经胸超声心动图[TTE]均未检测到），2例位于左心房体部。在这2例左心房体部血栓患者中，TTE并未明确显示血栓。7例LAA血栓患者通过双球囊技术接受了PMC。血流动力学和超声心动图结果与较大系列研究的结果相当。在手术过程中、术后48小时观察期内或平均12个月的随访中均未发现栓塞并发症。我们得出结论，对于接受抗凝治疗的LAA血栓患者，采用双球囊技术进行PMC可以安全实施。PMC前仍需行经食管超声心动图检查，因为TTE在检测左心房血栓方面效果欠佳。
