Diagnosis of Intracardiac Thrombi in Mitral Stenosis and Left Ventricular Dysfunction

Neovascularization of the left atrial appendage on selective coronary arteriography implying left atrial thrombus occurred in five of 20 patients with mitral stenosis, and is consistent with the incidence of left atrial thrombi in mitral stenosis determined both surgically and post mortem. The presence of a thrombus was confirmed at surgery in the two patients operated on. Selective coronary arteriography with attention to the presence or absence of left atrial neovascularization is suggested for the full evaluation of mitral stenosis. The absence of left atrial neovascularization in mitral stenosis strongly suggests, but does not confirm, the absence of left atrial thrombi. Left ventricular neovascularization was not found to be a sign of left ventricular thrombi, and left ventriculography remains the diagnostic procedure of choice in assessing the presence or absence of left ventricular thrombi.