Clinical Investigations Left Atrial Thrombi in Mitral Valve Disease and Coronary Angiography: Neovascularity and Fistula Formation

Angiographic findings of neovascularity and fistula formatian between the coronary arteries and left atrium have occasionally been reported in patients with rheumatic mitral valve disease. In this study, preoperative coronary angiograms were evaluated in 47 patients who underwent open mitral valve surgery. Atrial thrombosis was present in 11 patients (23 %). Ncovasculatiry at the lefl atrial wall was angiographically visualised in 7 of these 11 patients (64 %) and in all but one of them atrial thrombi were found at surgery. In 4 of 8 patients (50 %) neovascularity arose from the circumflex artery, in 1 of 8 patients (12 %) from the right coronary artery and in 3 of 8 patients (37 %) from both the circumflex and right coronary artery. In our study group, this angiographic pattern furnished the following diagnostic values: sensitivity 64 %, specificity 97 %, positive prediclive value 87 %. This study showed that in patients with mitral valve disease, coronary angiography may reveal the presence of neovasculatiry and fistula formation between the coronary arteries and left atrial thrombosis, but this method is only complementary in the diagnosis of atrial thrombosis.