Objectives To evaluate the safety and efficacy of percutaueous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis and thrombus in the left atrial appendage after thrombolytic and anticoagulation therapy.
Methods 25 patients, 20 women and 5 men, 37.4 ± 4.6 years, were diagnosed as simple mitral stenosis with thrombus in the left atrial appendage by transthoracic echocardiogram (TTE). All cases received Urokinase (200000u, intravenous injection, once a day), Aspirin (100 mg, oral, once a day), and Low-molecular-weight Heparins calcium (4100u, subcutaneous injection, once every 12 hours) treatment for 7 day and then did TTE again after discontinuation of these drugs for 48 hours. PBMV was performed by improved Inoue single balloon technique. Complications like bleeding and thromboembolism were observed during the operation and more then one year follow-up term.
Results Compared with before thrombolysis, Thrombus in the left atrial appendage in all patients were not completely faded, but was significantly reduced (residual thrombosis was organised thrombus). The technical success rate of PBMV was 100%. Left atrial mean pressure (LAPm) reduced instantly from (26.4 ± 5.6) mmHg to (11.6 ± 4.5) mmHg (P < 0.05) (1 mmHg = 0.133 kPa) and transmitral pressure gradient reduced instantly from (20.2 ± 3.6) mmHg to (5.8 ± 2.6) mmHg (P < 0.05) after PBMV. No bleeding and systemic thromboembolism events occurred during the operation and more then one year follow-up term. The parameters of hemodynamics, mitral valve area and cardiac function improved markedly.
Conclusions Thrombolytic therapy can dissolve fresh thrombus in a short period of time and shorten the preoperative anticoagulation time. It is safety and efficacy of PBMV in patients with mitral stenosis and thrombus in the left atrial appendage after thrombolytic and anticoagulation therapy in the hospitals with rich clinical experience.