Role of Oral Anticoagulation and Inoue Balloon Mitral Valvuloplasty in Presence of Left Atrial Thrombus: A Prospective Serial Transesophageal Echocardiographic Study
Bhuwanesh Kandpal MD, Naveen Garg MD, K. V. Anand MD, Aditya Kapoor MD, Nakul Sinha MD

Left atrial (LA) and/or left atrial appendage (LAA) thrombi are frequently found in patients with rheumatic mitral stenosis (MS), and may be considered as a contraindication for balloon mitral valvuloplasty (BMV). The efficacy of oral anticoagulation to resolve these thrombi was studied with serial transesophageal echocardiography (every two months, maximum total duration six months) and the feasibility of BMV using the Inoue balloon technique was assessed. Among 66 patients who completed the study, complete resolution of thrombi was seen in 22 (33.3%), and organization in 38 (57.6%) patients. Successful BMV could be performed in all these patients without complications. No significant change was observed in six patients (9.1%). To conclude, anticoagulant therapy is effective in resolution and/or organization of LA thrombi in patients with MS. BMV using the Inoue balloon technique may be safely performed after resolution or organization of thrombus, with no additional risk of complications.