| Summary: | 博士 === 國立臺灣大學 === 臨床醫學研究所 === 82 === Systemic arterial embolization is a frequent and sometimes
catastrophic complication in patients with rheumatic heart
disease, especially among those with mitral valve involvement.
Intracardiac mural thrombl were thought to be the source of
systemic arterial embolization. The newly developed
transesophageal echocardiography (TEE) , with its proximity to
left atrium (LA), provides better resolution of LA and LA
appendage than other diagnostic tools. In addition to LA
thrombus, TEE helps to detect intracavitary spontaneous echo
contrast, a phenomenon most commonly found in LA among pstients
with mitral valve disease or AF. The dissertation will first
review the current status of rheumatic heart disease in Taiwan
and the importance of systemic arterial embolization among
these patients. Next, using surgical and pathological findings
as the gold standard, the diagnostic accuracy of LA thrombi by
TEE is explored. With the help of TEE, the association between
LA thrombi and systemic arterial embolization was
substantiated. Our study also demonstrates that LA spontaneous
echo contrast is the only independent predictor for systemic
arterial embolization in these patients. Analysis on clinical
characteristics, echocardiographic and hemodynamic parameters
shows that atrial fibrillation, LA size and severity of mitral
stenosis all correlate with the presence of spontaneous echo
contrast. Information on LA appendage function, platelet
aggregability and hematocrit has also been analyzed to
delineate the possible mechanism for spontaneous echo contrast
formation. Such knowledge may guide the use of anticoagulant or
antiplatelet therapy to prevent systemic arterial embolization
in patients with rheumatic heart disease.
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