Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading

Basheeruddin Ansari; Sumaira Siddiqui; Vijay Barge; Pravat Kumar Dash

doi:doi:10.11648/j.ccr.20200404.15

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Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading

Basheeruddin Ansari, Sumaira Siddiqui, Vijay Barge, Pravat Kumar Dash

Published in Cardiology and Cardiovascular Research (Volume 4, Issue 4)

Received: 21 September 2020 Accepted: 12 October 2020 Published: 26 October 2020

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Abstract

Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA<1.5cm²) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (E_LAA Velocity, A_LAA Velocity, S_LAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.

Published in	Cardiology and Cardiovascular Research (Volume 4, Issue 4)
DOI	10.11648/j.ccr.20200404.15
Page(s)	196-202
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

PTMC, Left Atrial Appendage, Mitral Stenosis, Transesophageal Echocardiography, Spontaneous Echo Contrast

References

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[2]	Hondo T, Okamoto M, Yamane T, et al. The role of the left atrial appendage. A volume loading study in open-chest dogs. Jpn Heart J 1995; 36: 225-234.
[3]	Goswami KC, Yadav R, Bahl VK. Predictors of left atrial appendage clot: a trans esophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis. Indian Heart J. 2004; 56: 628-635.
[4]	Manish Bansal, Ravi R. Kasliwal. Echocardiography for left atrial appendage structure and function. Indian Heart J. 2012; 64: 469-475.
[5]	Beppu S, Nimura Y, Sakakibara H, Nagata S, Park YD, Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance. Journal of the American College of Cardiology. 1985; 6: 744–749.
[6]	V. Ganeswara Reddy, D. Rajasekhar, V. Vanajakshamma. Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: Transesophageal echo study. Indian heart journal. 2012; 64: 462-468.
[7]	Fatkin D, sKelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. Jam Coll Cardiol. 1994; 23: 961-969.
[8]	Sigel B, Coelho JC, Schade SG, Justin J, Spigos DG. Effect of plasma proteins and temperature on echogenicity of blood. Investigative Radiology. 1982; 17: 29–33.
[9]	Sigel B, Machi J, Beitler JC, Justin JR. Red cell aggregation as a cause of blood-flow echogenicity. Radiology. 1983; 148: 799–802.
[10]	Izumida Y, Seiyama A, Maeda N. Erythrocyte aggregation: bridging by macromolecules and electrostatic repulsion by sialic acid. Biochimica and Biophysica Acta. 1991; 1067: 221–226.
[11]	Black IW, Chesterman CN, Hopkins AP, Lee LC, Chong BH, Walsh WF. Hematologic correlates of left atrial spontaneous echo contrast and thromboembolism in nonvalvular atrial fibrillation. Journal of the American College of Cardiology. 1993; 21: 451–457.
[12]	Rajesh Vijayvergiya, Rajat Sharma, Ranjan Shetty et al. Effect of Percutaneous Transvenous Mitral Commissurotomy on Left Atrial Appendage Function: An Immediate and 6-Month Follow-Up Transesophageal Doppler Study. Journal of the American Society of Echocardiography. 2011; 11: 1260-1267.
[13]	Naser Aslanabadi, Iraj Jafaripour, Mehrnoush Toufan et al. The Effects of Percutaneous Mitral Balloon Valvuloplasty on the Left Atrial Appendage Function in Patients With Sinus Rhythm and Atrial Fibrillation. J Cardiovasc Thorac Res. 2015; 1: 32-37.
[14]	Karakaya O, Turkmen M, Bitigen A, et al. Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: a Doppler tissue study. Jam SocEchocardiogr. 2006; 19: 434-437.
[15]	Jean Marc Porte, Bertrand Cormier, Bernard lung et al. Early Assessment by Transesophageal Echocardiography of Left Atrial Appendage Function After Percutaneous Mitral Commissurotomy. Am J Cardiol. 1996; 77: 72-76.
[16]	Bertrand Cormier, Alec Vahanian, Bernard lung et al. Influence of percutaneous mitral commissurotomy on left atrial spontaneous contrast of mitral stenosis. The American Journal of Cardiology 1993; 71: 842–847.

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APA Style

Basheeruddin Ansari, Sumaira Siddiqui, Vijay Barge, Pravat Kumar Dash. (2020). Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiology and Cardiovascular Research, 4(4), 196-202. https://doi.org/10.11648/j.ccr.20200404.15

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ACS Style

Basheeruddin Ansari; Sumaira Siddiqui; Vijay Barge; Pravat Kumar Dash. Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiol. Cardiovasc. Res. 2020, 4(4), 196-202. doi: 10.11648/j.ccr.20200404.15

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AMA Style

Basheeruddin Ansari, Sumaira Siddiqui, Vijay Barge, Pravat Kumar Dash. Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiol Cardiovasc Res. 2020;4(4):196-202. doi: 10.11648/j.ccr.20200404.15

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@article{10.11648/j.ccr.20200404.15,
  author = {Basheeruddin Ansari and Sumaira Siddiqui and Vijay Barge and Pravat Kumar Dash},
  title = {Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {4},
  pages = {196-202},
  doi = {10.11648/j.ccr.20200404.15},
  url = {https://doi.org/10.11648/j.ccr.20200404.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200404.15},
  abstract = {Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA2) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.},
 year = {2020}
}

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TY  - JOUR
T1  - Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading
AU  - Basheeruddin Ansari
AU  - Sumaira Siddiqui
AU  - Vijay Barge
AU  - Pravat Kumar Dash
Y1  - 2020/10/26
PY  - 2020
N1  - https://doi.org/10.11648/j.ccr.20200404.15
DO  - 10.11648/j.ccr.20200404.15
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 196
EP  - 202
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20200404.15
AB  - Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA2) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.
VL  - 4
IS  - 4
ER  -

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Author Information

Basheeruddin Ansari

Department of Cardiology, Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India
Sumaira Siddiqui

Department of Pathology, Regency Hospital, Kanpur, Uttar Pradesh, India
Vijay Barge

Department of Medicine, Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India
Pravat Kumar Dash

Department of Cardiology, Hitech Medical College, Bhubaneswar, Orissa, India

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APA Style

Basheeruddin Ansari, Sumaira Siddiqui, Vijay Barge, Pravat Kumar Dash. (2020). Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiology and Cardiovascular Research, 4(4), 196-202. https://doi.org/10.11648/j.ccr.20200404.15

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ACS Style

Basheeruddin Ansari; Sumaira Siddiqui; Vijay Barge; Pravat Kumar Dash. Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiol. Cardiovasc. Res. 2020, 4(4), 196-202. doi: 10.11648/j.ccr.20200404.15

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AMA Style

Basheeruddin Ansari, Sumaira Siddiqui, Vijay Barge, Pravat Kumar Dash. Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading. Cardiol Cardiovasc Res. 2020;4(4):196-202. doi: 10.11648/j.ccr.20200404.15

Copy | Download

@article{10.11648/j.ccr.20200404.15,
  author = {Basheeruddin Ansari and Sumaira Siddiqui and Vijay Barge and Pravat Kumar Dash},
  title = {Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {4},
  pages = {196-202},
  doi = {10.11648/j.ccr.20200404.15},
  url = {https://doi.org/10.11648/j.ccr.20200404.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200404.15},
  abstract = {Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA2) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Study of Left Atrial Appendage Function in Patients of Severe Rheumatic Mitral Stenosis and Effect of Successful PTMC on SEC Grading
AU  - Basheeruddin Ansari
AU  - Sumaira Siddiqui
AU  - Vijay Barge
AU  - Pravat Kumar Dash
Y1  - 2020/10/26
PY  - 2020
N1  - https://doi.org/10.11648/j.ccr.20200404.15
DO  - 10.11648/j.ccr.20200404.15
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 196
EP  - 202
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20200404.15
AB  - Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA2) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.
VL  - 4
IS  - 4
ER  -

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