Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1981 Feb;45(2):148–156. doi: 10.1136/hrt.45.2.148

Detection of left atrial thrombi by echocardiography.

P Schweizer, P Bardos, R Erbel, J Meyer, W Merx, B J Messmer, S Effert
PMCID: PMC482503  PMID: 7459174

Abstract

A group of 111 patients with mitral valve disease was studied by M-mode and two-dimensional echocardiography. Five left atrial thrombi were demonstrated, two of which had probably been the source of previous embolic events. Two-dimensional echocardiography was superior to M-mode in providing spatial orientation. Using multiple cross-sections the exact localisation and the size of the thrombus formation could be estimated. Thrombus localisations at the upper, lateral, and septal atrial walls, normally inaccessible to the single-beam technique, were successfully imaged. Even two-dimensional echocardiography, however, constitutes an imperfect method. By comparison with the findings at surgery only one-third of confirmed thrombi could be detected non-invasively. According to their localisation seven clots in the appendage were missed by the ultrasound method. One further thrombus fixed to the upper left atrial wall near the entrance of the upper pulmonary veins was also undetected by echocardiography. Despite these limitations, the information provided by echocardiography can be most helpful in patient management. M-mode, in combination with two-dimensional echocardiography, is therefore recommended in all patients with mitral stenosis before diagnostic or therapeutic procedures are undertaken.

Full text

PDF
156

Images in this article

150Image
on p.150
150Image
on p.150
151Image
on p.151
152Image
on p.152
152Image
on p.152
153Image
on p.153
154Image
on p.154
154Image
on p.154
155Image
on p.155

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. DeMaria A. N., Bommer W., Neumann A., Grehl T., Weinart L., DeNardo S., Amsterdam E. A., Mason D. T. Left ventricular thrombi identified by cross-sectional echocardiography. Ann Intern Med. 1979 Jan;90(1):14–18. doi: 10.7326/0003-4819-90-1-14. [DOI] [PubMed] [Google Scholar]
  2. EFFERT S., DOMANIG E. Diagnostik intraaurikulärer Tumoren und grosser Thromben mit dem Ultraschall-Echoverfahren. Dtsch Med Wochenschr. 1959 Jan 2;84(1):6–8. doi: 10.1055/s-0028-1113531. [DOI] [PubMed] [Google Scholar]
  3. Furuse A., Mizuno A., Inoue H., Furuta N., Saigusa M. Echocardiography and angiocardiography for detection of left atrial thrombosis. Jpn Heart J. 1976 Mar;17(2):163–171. doi: 10.1536/ihj.17.163. [DOI] [PubMed] [Google Scholar]
  4. Graboys T. B., Sloss L. J., Ockene I. A. Echocardiographic diagnosis of left atrial thrombus - a case report. J Clin Ultrasound. 1977 Aug;5(4):284–285. doi: 10.1002/jcu.1870050417. [DOI] [PubMed] [Google Scholar]
  5. JORDAN R. A., SCHEIFLEY C. H., EDWARDS J. E. Mural thrombosis and arterial embolism in mitral stenosis; a clinico-pathologic study of fifty-one cases. Circulation. 1951 Mar;3(3):363–367. doi: 10.1161/01.cir.3.3.363. [DOI] [PubMed] [Google Scholar]
  6. Kisslo J. A., vonRamm O. T., Thurstone F. L. Dynamic cardiac imaging using a focused, phased-array ultrasound system. Am J Med. 1977 Jul;63(1):61–68. doi: 10.1016/0002-9343(77)90118-8. [DOI] [PubMed] [Google Scholar]
  7. Kossowsky W. A., Bleifer S. B. Fatal cerebral embolism complicating transseptal left heart catheterization. Circulation. 1965 Nov;32(5):811–813. doi: 10.1161/01.cir.32.5.811. [DOI] [PubMed] [Google Scholar]
  8. Lewis K. B., Criley J. M., Ross R. S. Detection of left atrial thrombus by cineangiocardiography. Am Heart J. 1965 Nov;70(5):612–619. doi: 10.1016/0002-8703(65)90390-x. [DOI] [PubMed] [Google Scholar]
  9. Mikell F. L., Asinger R. W., Rourke T., Hodges M., Sharma B., Francis G. S. Two-dimensional echocardiographic demonstration of left atrial thrombi in patients with prosthetic mitral valves. Circulation. 1979 Nov;60(5):1183–1190. doi: 10.1161/01.cir.60.5.1183. [DOI] [PubMed] [Google Scholar]
  10. ORMOND R. S., DRAKE E. H., GALE H. H. ANGIOGRAPHIC STUDY OF THE LEFT ATRIUM IN MITRAL STENOSIS. Radiology. 1964 Aug;83:277–282. doi: 10.1148/83.2.277. [DOI] [PubMed] [Google Scholar]
  11. PARKER B. M., FRIEDENBERG M. J., TEMPLETON A. W., BURFORD T. H. PREOPERATIVE ANGIOCARDIOGRAPHIC DIAGNOSIS OF LEFT ATRIAL THROMBI IN MITRAL STENOSIS. N Engl J Med. 1965 Jul 15;273:136–143. doi: 10.1056/NEJM196507152730304. [DOI] [PubMed] [Google Scholar]
  12. Peterson L. M., Fisher R. D., Reis R. L., Morrow A. G. Cardiac operations in patients with left atrial thrombus. Incidence and prevention of postoperative embolism. Ann Thorac Surg. 1969 Nov;8(5):402–406. doi: 10.1016/s0003-4975(10)66070-5. [DOI] [PubMed] [Google Scholar]
  13. Ports T. A., Cogan J., Schiller N. B., Rapaport E. Echocardiography of left ventricular masses. Circulation. 1978 Sep;58(3 Pt 1):528–536. doi: 10.1161/01.cir.58.3.528. [DOI] [PubMed] [Google Scholar]
  14. Ross J., Jr Considerations regarding the technique for transseptal left heart catheterization. Circulation. 1966 Sep;34(3):391–399. doi: 10.1161/01.cir.34.3.391. [DOI] [PubMed] [Google Scholar]
  15. SAMET P., BERNSTEIN W. H., LEVINE S. TRANSSEPTAL LEFT HEART CATHETERIZATION. AN ANALYSIS OF 390 STUDIES. Dis Chest. 1965 Aug;48:160–166. doi: 10.1378/chest.48.2.160. [DOI] [PubMed] [Google Scholar]
  16. SOLOFF L. A., ZATUCHNI J. The angiocardiographic diagnosis of left atrial thrombosis. Circulation. 1956 Jul;14(1):25–32. doi: 10.1161/01.cir.14.1.25. [DOI] [PubMed] [Google Scholar]
  17. Schattenberg T. T. Echocardiographic diagnosis of left atrial myxoma. Mayo Clin Proc. 1968 Sep;43(9):620–627. [PubMed] [Google Scholar]
  18. Silverman N. H., Schiller N. B. Apex echocardiography. A two-dimensional technique for evaluating congenital heart disease. Circulation. 1978 Mar;57(3):503–511. doi: 10.1161/01.cir.57.3.503. [DOI] [PubMed] [Google Scholar]
  19. Spangler R. D., Okin J. T. Illustrative echocardiogram: echocardiographic demonstration of a left atrial thrombus. Chest. 1975 Jun;67(6):716–718. doi: 10.1378/chest.67.6.716. [DOI] [PubMed] [Google Scholar]
  20. Tajik A. J., Seward J. B., Hagler D. J., Mair D. D., Lie J. T. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. Mayo Clin Proc. 1978 May;53(5):271–303. [PubMed] [Google Scholar]
  21. Tallury V. K., DePasquale N. P. Ultrasound cardiography in the diagnosis of left atrial thrombus. Chest. 1971 May;59(5):501–503. doi: 10.1378/chest.59.5.501. [DOI] [PubMed] [Google Scholar]
  22. Verska J. J., Ludington L. G., Walker W. J., Mundall S., Brewer L. A., 3rd The occurrence and management of left atrial thrombi in mitral valve surgery. J Cardiovasc Surg (Torino) 1974 Sep-Oct;15(5):516–521. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES