Percutaneous balloon mitral valvuloplasty (PBMV) described by Inoue et al, is a safe FDA (Food and Drug Administration) approved procedure in patients with severe mitral stenosis. One of the contraindications of the procedure is presence of a left atrial thrombus; however, it has been reported that intense warfarin therapy may led to disso lution of the thrombus. The authors report a patient who was referred for PBMV and was found to have a left atrial thrombus. After intense warfarin therapy, successful PBMV was undertaken without complications.
References
1.
Inoue K., Owaki T., Nakamura T., et al: Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg87:394-402, 1984.
2.
Complications and mortality of percutaneous balloon mitral commissurotomy: A report from the National Heart, Lung and Blood Institute Balloon Valvuloplasty Registry. Circulation85:2014-2023, 1992.
3.
Tessier P., Mercier LA, Burelle D., et al: Results of percutaneous mitral commissurotomy in patients with a left atrial appendage thrombus detected by transesophageal echocardiography . J Am Soc Echocardiogr7:394-399, 1994.
4.
Yamamoto K., Ikeda U., Seino Y., et al: Coagulation activity is increased in the left atrium of patients with mitral stenosis. J Am Coll Cardiol25:107-112, 1995.
5.
Peverill RE, Harris G., Gelman J., et al: Effect of warfarin therapy on regional left atrial coagulation activity in mitral stenosis. Am J Cardiol79:339-343, 1997.
6.
Beppu S., Park YD, Sakakibara H. , et al: Clinical features of intracardiac thrombosis based on echocardiographic observation. Jpn Circ J48:75-82, 1984.
7.
Tsai LM, Hung JS, Chen JH, et al: Resolution of left atrial appendage thrombus in the mitral stenosis after warfarin therapy. Am Heart J121:1232-1234, 1991.
8.
Hung JS, Lin FC, Chiang CW: Successful percutaneous transvenous catheter balloon mitral commissurotomy after warfarin therapy and resolution of left atrial thrombus. Am J Cardiol64:126-128, 1989.
