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A multivariate analysis of the most likely predictors of left atrial thrombi formation among children with mitral stenosis.


Juliet J. Balderas,
Ma. Lourdes S. Casas,
Wilberto I. Lopez

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Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
October-December 1997


BACKGROUND. Thrombus formation has been postulated to be due to stasis of blood in mitral stenosis (MS) - the risk increasing as it approaches critical mitral vale area (MVA) (1.0 cm). Among adults, several risk factors for left atrial (LA) thrombus formation has been identified but no studies have been done among children. Once identified, can an argument be made for earlier anti-coagulation should factors predictive of LA thrombus or rheologic stasis be present by echocardiography?

OBJECTIVE. This retrospective study was conceptualized to determine different factors most likely to predict LA thrombus formation among children (ages 18 years) with moderate to severe mitral stenosis.

METHOD AND RESULTS. All pediatric patients who underwent open mitral commissurotomy (OMC) between January 1990 to December 1996 at the Philippine Heart Center were included and intraoperative finding of LA thrombus was used as gold standard. Review of charts for different variables were done and a p value < 0.05 was considered significant. There were 49 children enrolled in the study, 33% had intraoperative LA thrombus formation. All had rheumatic heart disease with ages 8-18 years (mean 14), with no significant sex predilection. Among children, in contrast to that seen in adults, the most likely predictors of LA thrombus formation are an increased trasmitral gradient (p=0.035) and an increased LA diameter by at least 60% difference from the expected LA diameter for weight (p=0.005). Other variables such as age, atrial fibrillation, and other echocardiographic parameters were not predictive in this age group.

CONCLUSION AND RECOMMENDATION. Early detection for possible early anticoagulation among children should be considered and further investigated to decrease risk for embolization. Likewise, more children with significant MS can be enrolled for percutaneous mitral balloon valvuloplasty (PMBV) versus OMC which has been associated with more complications.


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