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Assessment of left atrial appendage filling pattern by using intravenous administration of microbubbles: Comparison between mitral stenosis and mitral regurgitation

Authors
 Jong-Won Ha  ;  Byung-Kwon Lee  ;  Hyun-Joo Kim  ;  Wook-Bum Pyun  ;  Ki-Hyun Byun  ;  Se-Joong Rim  ;  Namsik Chung 
Citation
 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, Vol.14(11) : 1100-1106, 2001 
Journal Title
 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY 
ISSN
 0894-7317 
Issue Date
2001
MeSH
Aged ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/physiopathology* ; Case-Control Studies ; Contrast Media/administration & dosage ; Coronary Thrombosis/etiology ; Coronary Thrombosis/physiopathology ; Echocardiography, Transesophageal ; Female ; Fluorocarbons/administration & dosage ; Glucose/administration & dosage ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Mitral Valve Insufficiency/complications ; Mitral Valve Insufficiency/physiopathology* ; Mitral Valve Stenosis/complications ; Mitral Valve Stenosis/physiopathology* ; Reference Values ; Serum Albumin/administration & dosage ; Serum Albumin, Human ; Stroke Volume
Abstract
Mitral stenosis (MS) and mitral regurgitation (MR) are the most frequent conditions that cause a dilation and dysfunction of the left atrial appendage (LAA). Despite similarly dilated LAA in patients with MS and MR, the incidence of LAA thrombi and the risk of thromboembolism is different between these patients. The purpose of this study was to characterize the filling pattern of LAA by using intravenous administration of perfuorocarbon-exposed dextrose albumin (PESDA) during transesophageal echocardiographic examination in patients with MS and MR. Twenty-four patients with moderate to severe MS, 12 patients with severe MR, and a control group including 30 patients with conditions other than mitral valve disease underwent transesophageal echocardiographic examination with an intravenous bolus injection of PESDA. LAA emptying and filling velocities and maximal and minimal areas of LAA and LAA ejection fraction were measured. Digital gray-scale intensity (GSI) of the left atrial (LA) and LAA cavity after PESDA injection was measured by off-line analysis. Compared with control patients, patients with MS or MR had larger maximal and minimal areas of LAA and reduced LAA ejection fraction. LAA peak emptying flow velocity was significantly lower in patients with MS compared with those of MR or control patients. LAA peak filling velocity was significantly lower in patients with MS compared with that of control patients. However, there was no significant difference of LAA peak filling velocity between the patients with MS and MR. There was no significant difference of GSI ratio of LAA and LA between patients with MR and control patients; however, GSI ratio of LAA and LA was significantly lower in patients with MS compared with that of MR. The incidence of LAA spontaneous echo contrast and LAA thrombi in patients with MS was significantly higher than that of the patients with MR and control subjects (P < .005). Despite similarly dilated LAA area and depressed contractile function of LAA in patients with MS and MR compared with control patients, profoundly impaired LAA filling with resultant flow stasis was demonstrated by contrast echocardiography in patients with MS. These findings may explain the higher incidence of LAA spontaneous echo contrast and thrombus in patients with MS.
Full Text
http://www.sciencedirect.com/science/article/pii/S0894731701900653?np=y
DOI
10.1067/mje.2001.114395
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/142986
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