승모판 협착증 환자에 있어서 좌심방내 Spontaneous Echo Contrast 에 관한 연구 - 경흉부 및 정식도 심초음파도의 비교관찰 - = Clinical Implication of Left Atrial Spontaneous Echo Contrast in Patients with Mitral Stenosis : Comparison between Transthoracic and Transesophageal Echocardiography

다국어 초록 (Multilingual Abstract)

Objectives: Left atrial thrombus (LAT) has been known as a major cause of systemic arteria1 embolization in patients with mitral stenosis. This study was undertaken to compare the diagnostic efficacy of transthoracic echocardiography (TTE) with that of transesophageal echocardiography (TTE) in the detection of LAT, Additionally, we assessed the prevalence and clinical significance of left atrial SEC and the factors related to its presence in patients with mitral stenosis. Methods; The study group comprised 33consecutive patients who had mitral stenosis (MS) or mitral stenoinsufficiency, 26patients of them had atrial fibrillation (AF), 7patients had sinus rhythm. Among them, 14cases had systemic embolization. All patients were studied with transthoracic and transesophageal echocardiography. We measured left atrial dimension (LAD), mitral valve area (MVA), ejection fraction (EF), severity of mitral regurgitation, and examined the presence and location of LAT and SEC by TTE and TEE. Cardiac rhythm, history of systemic cmbolization were collected by review of the patients hospital records. Results: 1) TTE revealed left atrial SEC in only 1patient. In contrast, left atrial SEC clould be detected in 25patients by TEE. In 8patients, LAT were diagnosed by TTE, whereas detected 14cases of LAT by TEE. The difference between two methods was statistically significant (p<0 05). 2) The patients with LAT had significantly highter prevalence of SEC and AF, lower EF, lower frequency of severe mitral regurgitation than in patients without LAT (p<0 05). But, MVA and LAD were not significantly different between two groups. 3) Patients with SEC had significaotly higher frequency of AF and history of systemic embolization, more severe stenosis of MVA, lower frequency of severe mitral regurgitation than in patients without SEC (p<0, 05). But LAD and EF were not significantly different between two groups. 4) LAT or systemic embolization, or both were found in 20 of 25patients (80%) with SEC. Whereas, only 1 of 8patients (13%) without SEC had a history of arterial embolization (p<0,01), and no patient without SEC was found to have thrombus within the left atrium, Conclusion: This results suggested that TEE was more sensitive to detect left atrial SEC and LAT than TTE, and left atrial SEC was strong predictor for thrombus formation and systemic embolization in patients with mitral stenosis.