Morphological and functional changes in left atrial appendage after index percutaneous balloon mitral valvotomy

Introduction In properly selected patients, percutaneous balloon mitral valvotomy obtains excellent immediate and sustained hemodynamic improvement, comparable to the results of surgical procedures, including open or closed mitral commissurotomy and mitral prosthetic replacement. Left atrial appendage acts as a chamber to depressurize the left atrium. In due course of severe rheumatic mitral stenosis, the left atrial appendage becomes dilated and loses its contractile function. When the left atrium is depressurized, left atrial appendage should be able to regain its contractile function and reduces in size. Scarce research has been done on left atrial appendage pre and post percutaneous balloon mitral valvotomy. Objectives To compare left atrial appendage area by 2D & 3D transthoracic and/or transesophageal echocardiography imaging pre and post PBMV. To compare the left atrial appendage emptying and filling velocities by 2D & 3D transthoracic and/or transesophageal echocardiography imaging pre and post PBMV. Methods 19 patients fulfilled all the inclusion and exclusion criteria. Transthoracic and transesophageal echo were done prior to PBMV and 24 hours after PBMV with due precautions. Mitral valve area, transmitral gradient, quantification of mitral regurgitation, LAA area (450, 900 and mean), LAA early filling velocity, LAA late filling velocity, LAA early emptying velocity and LAA late emptying velocity. Quantitative variables were assessed by paired T-test. Correlations were performed by with linear regression and Pearson’s coefficient. P<0.05 were taken as significant in all statistical comparisons. Results The mean 2-dimensional MVOA of 0.79±0.16 cm2 prior to PBMV increased to 1.87±0.25 cm2 post PBMV (p<0.001). The mean MVGp of 21.6±6.82 mm Hg prior to PBMV reduced to 11.6± 2.73 mm Hg after successful PBMV (p<0.001). The mean MVGm of 13±4.1 mm Hg prior to PBMV was reduced to 4.84±1.1 mm Hg after successful PBMV (p<0.001). The mean LAA area at 450 was 5.43±0.78 cm2 which decreased to 4.74±0.62 cm2 after successful PBMV (p<0.001). The mean LAA area at 900 was 5.43±0.78 cm2 which decreased to 4.74±0.62 cm2 after successful PBMV (p<0.001). The mean LAA LEV increased from 21.71±4.01 cm/sec to 33.02±6.91 cm/sec following PBMV (p<0.001). The mean LAA EFV improved from 30.89±8.67 cm/sec to 42.26±12.12 cm/sec following PBMV (p<0.01). All the values obtained were analysed using paired t-Test and were statistically significant. Conclusion There is significant reduction of LAA area post successful PBMV signifying LAA can regain its size and morphology post PBMV. There is significant increase in LAA filling and emptying velocity post successful PBMV signifying regain of contractile function of LAA in patients with sinus rhythm.