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.