Assessment of Left Atrial Appendage Flows Before and After Percutaneous mitral Balloon Valvotomy in Patients With Mitral Stenosis

Formation of thrombus at the left atrial appendage is frequently seen in patients with mitral stenosis. The aim of this study was to assess the left atrial appendix (LAA) function before and after percutaneous mitral balloon valvotomy (PMV). We studied 10 healthy persons and 20 patients with mitral stenosis. We performed PMV by using the Inoue technique in 10 patients. We performed transthoracic (TTE) and transesophageal echocardiography (TEE) in the control group; TTE, TEE and cardiac catheterization in patients with mitral stenosis before and after valvotomy. Twelve patients had sinus rhythm and 8 patients were in atrial fibrillation. Spontaneous contrast was present in 14 patients and was absent in 6 patients. The left atrial appendix area (LAAA) max., LAAA min. and LAA ejection fraction (EF) were 1.67±0.53 cm2, 0.68±0.22 cm2 and %59±4 in control groups, respectively. Mean peak velocities of the filling and emptying waves were 28.5±2.17 cm/sec and 30.4±2.46 cm/sec in the control group, respectively. We found that appendix area was increased and appendix ejection fraction was reduced, and appendix flow velocity was reduced. LAAAmax., LAAAmin., LAA EF, mean peak velocities of the filling and emptying wave were 3.19±0.65 cm2, 2.67±0.5 cm2, 16.4%, 16.5±1.8 cm/sec and 16.3±1.53 cm/sec., respectively. The mitral valve area was increased from 1.12±0.21 cm2 to 2.17±0.24 cm2 (p=00001) after PMV (immediate) appendix area max., and min. were significantly reduced, appendix ejection fraction was improved from 17±5% to 35±5% (p=0.0001), mean peak velocities of filling and emptying waves were increased from 15.4±2.1 to 22.6±2.4 and 15.8±1.48 to 22.9±2.4, respectively, One month after PMV, appendix function was also showing a trend toward improvement (p < 0.001, p < 0.003, p < 0.001, respectively). Thus, immediate assessment of the LAA function after PMV shows global improvement of the appendix function and Doppler outflow. One month after PMV, this improvement trend continued.