ORIGINAL PAPER
Safety of percutaneous balloon mitral commissurotomy in patients with thrombus in the left atrial appendage

Percutaneous mitral balloon commissurotomy (PMC) is an effective therapeutic method of treatment for patients with symptomatic mitral stenosis. The presence of a left atrial thrombus is generally considered as contraindication to PMC. However, if thrombus is entirely within the left atrial appendage the risk of embolic complication is lower.
Aim: To assess the safety and efficacy of PMC in patients with mitral stenosis and left atrial appendage thrombus.
Material and methods: To identify patients with left atrial thrombus transesophageal echocardiographic examination was performed for all candidates of PMC. The thrombus entirely within the left atrium appendage was found in 39 (2.9%) of 1 353 patients referred for PMC. All 39 patients underwent PMC with the Inoue balloon catheter.
Results: PMC was successful in 38 of patients with left atrial appendage thrombus. One patient required emergency surgery because of significant mitral regurgitation. None had evidence of embolism after PMC. Significant improvements in mitral valve area (1.18±0.2 cm² before PMC and 1.83±0.4cm² after PMC, p <0.001), mean mitral pressure gradient (8.3±3.1 mmHg before and 4.2±1.5 mmHg after PMC, p <0.001), pulmonary artery systolic pressure (50.9±17.5 mmHg before and 39.9±14.9 mmHg after PMC, p <0.001) were observed.
Conclusion: In patients with mitral stenosis who have left atrial appendage thrombus percutaneous mitral balloon commissurotomy with the Inoue balloon catheter is safe and effective method of treatment.