Left atrial spontaneous echo contrast as a predictor of systemic arterial embolization in rheumatic mitral valve disease: a transesophageal echocardiographic study.

The relationship between systemic arterial embolization and left atrial spontaneous echo contrast (LASEC) was investigated in 90 consecutive patient with rheumatic mitral valve disease (52 patients had predominant mitral stenosis, 14 had significant mitral regurgitation and 24 with xenograft mitral valve replacement), during a 2-year period. LASEC was defined as the presence of dynamic echos (smoke-like) curling up in a circular pattern within the left atria, by transesophageal echocardiography (TEE). LASEC was observed in 27 patients (group A) and was absent in 63 patients (group B). Group A patients showed a higher frequency of left atrial thrombi or history of previous embolization than those in group B (59.2% vs. 7.3%; p < 0.001). Group A patients also had a higher frequency of recent (10 days before TEE study) and remote (more than 10 days before TEE study) embolization than did group B patients (recent: 22.2% vs. 1.6%; p < 0.001; remote: 11.1% vs. 4.7%, p < 0.001). Thus patients with LASEC had a significantly higher risk for thromboembolism and TEE is a useful modality to identify this subset of patients with rheumatic mitral valve disease.