Doppler echocardiographic estimation of transmitral pressure gradients and correlations with micromanometer gradients in mitral stenosis

Left atrial (LA) thrombus is a frequent complication of mitral valve disease.1,2 Transthoracic 2-dimensional echocardiography, a safe noninvasive test, allows serial follow-up examinations of patients and is therefore the choice diagnostic technique for detecting LA thrombi. Although 2-dimensional echocardiography has a sensitivity of 75 to 78% and a specificity of 99 to 100% in detecting LA cavity thrombi, it is insensitive in detecting thrombi in the LA appendage.1,2 The recently introduced transesophageal echocardiographic method readily visualizes thrombi in the LA appendage3 and, thus, may complement the traditional transthoracic 2-dimensional echocardiographic examination. However, transesophageal transducers are not widely available at present, and their diagnostic sensitivity and specificity have been reported in a limited number of patients.3 Standen,4 using selective coronary angiography in 1975, described "tumor vascularity" with abnormal vessels arising from the left circumflex artery to the left atrium in a patient with severe mitral stenosis. An LA thrombus was found at surgery. Colman et al,5 in a retrospective study of a large number of patients with mitral valve disease, showed coronary neovascularization with fistula formation as a specific sign for the presence of LA thrombi. To define their diagnostic usefulness for detecting LA thrombi, we performed both coronary angiography and 2-dimensional echocardiography before mitral valve surgery in patients with severe rheumatic mitral stenosis. © 1991.