Left and right atrial function after percutaneous mitral valvuloplasty in mitral stenosis and sinus rhythm

• Published in: The Journal of heart valve disease Vol. 17; no. 5; pp. 492 - 500
• Main Authors: Cianciulli, Tomás F, Saccheri, María C, Lax, Jorge A, Sarmiento, Ricardo A, Bermann, Alejandra M, Gagliardi, Juan A, Cirio, Juan J, Dorelle, Adriana N, Prezioso, Horacio A, Vidal, Luis A
• Format: Journal Article
• Language: English
• Published: England 01-09-2008
• Subjects: Adult; Atrial Function, Left - physiology; Atrial Function, Right - physiology; Catheterization; Echocardiography, Doppler, Pulsed; Echocardiography, Transesophageal; Female; Heart Rate - physiology; Humans; Male; Middle Aged; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - physiopathology; Mitral Valve Stenosis - therapy; Myocardial Contraction - physiology; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Pulmonary Wedge Pressure - physiology; Young Adult
• ISSN: 0966-8519

Percutaneous mitral valvuloplasty (PMV) is an effective method for treating patients with severe mitral stenosis. The study aim was to compare left and right atrial appendage functions before and after PMV.
Twenty-five patients (23 women, two men; mean age 38 +/- 9 years; range: 21-57 years) with severe mitral stenosis and sinus rhythm who underwent PMV were included in the study. Transesophageal echocardiography (TEE) was performed before and at six months after PMV, to evaluate the intensity of spontaneous echo contrast (SEC), left atrial appendage (LAA) dimensions and function, and right atrial appendage (RAA) function.
After PMV, the SEC (at TEE) was decreased in all patients, while increases were observed in the contraction and relaxation velocity flows of the LAA (pre-PMV 18 +/- 5 cm/s; post-PMV 24 +/- 9 cm/s; p < 0.001 and pre-PMV 25.5 +/- 10.2 cm/s; post-PMV 32.9 +/- 12.6 cm/s; p < 0.006, respectively). The tissue myocardial velocities were also increased in the LAA (pre-PMV 6.92 +/- 3.77 cm/s; post-PMV 11.16 +/- 6.61 cm/s; p < 0.002) and RAA (pre-PMV 16.2 +/- 3.7 cm/s; post-PMV 19.1 +/- 4.1 cm/s; p < 0.001).
In patients with mitral stenosis and sinus rhythm, improvements were noted in the left atrial, LAA and RAA systolic functions after PMV. This suggests that the relief of mitral stenosis may not only confer hemodynamic benefits to improve symptoms but also have a favorable influence on future thromboembolic complications. Thus, an early intervention might benefit patients with sinus rhythm by preventing the development of atrial fibrillation and systemic and pulmonary embolism.