Left atrial appendage thrombus with severe mitral stenosis: Responders and non-responders to anticoagulation

Mitral stenosis (MS) is one of the most frequently observed valvular heart lesions in developing countries and is due to different etiologies. The effects of anticoagulation in different types of left atrial appendage (LAA) are unknown. The current study aimed to determine the resolution of LAA thrombus on transesophageal echocardiography (TEE) after three months of optimal anticoagulation in patients with different types of LAA at baseline cardiac computed tomography of patients with severe MS. This prospective cohort study observed the frequency of LAA thrombus resolution after three months of anticoagulation therapy in patients with severe MS. The response rate in different morphologies of LAA and locations was also assessed. Thrombus resolution after three months of warfarin therapy was assessed on repeat TEE. A total of 88 patients were included, mean age 37.95±11.87 years. Repeat TEE showed thrombus resolution in only 27.3% of patients. The rate of thrombus resolution was 8/12 (66.7%), 4/28 (14.3%), 8/36 (22.2%), and 4/12 (33.3%) for patients with cactus, cauliflower, chicken wing, and windsock LAA type, respectively. The resolution rate was 0/12 (0%), 4/44 (9.1%), and 20/32 (62.5%) for patients with thrombus in the base, body, and tip of the LAA, respectively. The cactus type of LAA morphology and thrombus at the LAA tip responded well to three months of anticoagulation, however, patients with thrombus in the LAA base and body and cauliflower and chicken wing morphology were non-responders and could benefit from early referral for surgical management. A estenose mitral (EM) é uma das lesões cardíacas valvulares mais frequentemente observadas devido a diferentes etiologias em países em desenvolvimento. Os efeitos da anticoagulação em diferentes tipos de apêndice auricular esquerdo (AAE) são desconhecidos. Portanto, o presente estudo teve como objetivo determinar a resolução do trombo no AAE por meio de ETE após três meses de anticoagulação ideal entre pacientes com diferentes tipos de AAE na TC cardíaca basal de pacientes com grave EM. Este estudo prospetivo de coorte observou a frequência da resolução do trombo no AAE após três meses de terapia com anticoagulantes em pacientes com EM grave. A taxa de resposta em diferentes morfologias de AAE e suas localizações também foi analisada. A resolução do trombo após três meses de terapia com varfarina foi avaliada na repetição do ETE. Foram incluídos 88 pacientes, com idade média de 37,95 ± 12,08 anos. A r