Ann Thorac Surg 1996;62:1795
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Philip R. Liebson, MD
Cardiovascular Ultrasound Unit, Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
See also page 1790.
This study indicates the high percentage of asymptomatic patients with mechanical prosthetic valves having left atrial SEC or thrombi, especially in conjunction with atrial fibrillation. Because this study was performed on patients with a history of rheumatic heart disease, it is possible, as Lee and associates point out, that the increased coagulation tendency in rheumatic heart disease may have been partially responsible for this finding. Certainly the low blood flow pattern of atrial fibrillation and the atrial size were risk factors as well.
The importance of these findings is that in asymptomatic patients with prosthetic valves who are presumably adequately anticoagulated, the presence of SEC or thrombi will not be elucidated by physical examination or even transthoracic echocardiography. The study points up the possibility that transesophageal study may be prudent on an annual basis in asymptomatic patients with mechanical prosthetic valves secondary to rheumatic heart disease who have large atria or chronic atrial fibrillation. The evidence that thrombolytic therapy was effective in dispelling thrombi still begs the question of long-term therapy. It is possible that combinations of antiplatelet agents and higher international normalized ratio values of anticoagulants may be effective in dispelling thrombi and decreasing SEC.
Related Article
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Left Atrial Spontaneous Echo Contrast in Asymptomatic Patients With a Mechanical Valve Prosthesis
- Tsung-Ming Lee, Nai-Kuan Chou, Sheng-Fang Su, Yueh-Juh Lin, Ming-Fong Chen, Chiau-Suong Liau, Yuan-Teh Lee, and Shu-Hsun Chu
Ann. Thorac. Surg. 1996 62: 1790-1795.
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