Key result
Large left atrial appendix linked to ~3-fold higher systemic embolism risk in mitral stenosis.
Why the study?
Systemic embolism is more common in patients with mitral stenosis who have a large left atrial appendix, but the benefit of appendicectomy as protection against embolism was not well established.
Does left atrial appendicectomy and valve correction prevent systemic emboli in patients with mitral stenosis?
Observational
Yes
Does left atrial appendicectomy and valve correction prevent systemic emboli in patients with mitral stenosis?
Left atrial appendicectomy combined with valve correction was historically recommended to prevent recurrent systemic emboli in patients with mitral valve disease.
Answers are grounded in this paper and cite their sources.
Supports appendicectomy with valve correction to reduce emboli risk in mitral stenosis; leaves open need for randomized confirmation.
Systemi( Embolism-Somerville and Chambers moMEDMCALHNAL 1169 convey good protection against systemic emboli (Szekely, 1964).The operation designed to prevent further emboli consists of amputation of the appendix and correction when possible of the valve disease, even though it is trivial.Left atrial appendicectomy was recommended by Madden (1949), but he reported on only two cases, the results were not convincing, and he did not press home his argument. SummarySystemic embolism in patients with mitral stenosis was more than three times commoner when the left atrial appendix was large than when small.Conversely, the left atrial appendix was larger in patients with a history of embolism than in those without it.The occurrence of embolism rose steeply in successive decades when the appendix was large but not when it was small.The left atrial appendix should be amputated at mitral valvotomy as an extra precaution against embolism.A number of patients presenting with systemic embolism and only slight rheumatic mitral-valve involvement have disproportionate enlargement of the left atrial appendix.Amputation of the appendix and relief of mitral stenosis, how- ever slight, is recommended here as a protection against further emboli.We are grateful to the physicians and surgeons of the Middlesex and Harefield Hospitals, to Dr. A. Kardalinos, and to
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Lillicrap et al. (1964) conducted an observational in Mitral stenosis. Large left atrial appendix vs. Small left atrial appendix was evaluated on Systemic embolism. A large left atrial appendix in patients with mitral stenosis was associated with a more than 3-fold higher occurrence of systemic embolism compared to a small left atrial appendix.
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