Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance

In some patients with mitral stenosis, a smoke-like echo is observed in the left atrial cavity. The present study in 116 consecutive patients with rheumatic mitral valve disease investigated the echocardiographic features and clinical significance of this echo. The smoke-like echo is characterized by the following echocardiographic features: 1) it is composed of numerous microechoes; 2) it curls up slowly in the enlarged left atrial cavity; and 3) it vanishes as soon as it pours into the ventricular cavity. Hemostasis in the left atrial cavity was considered to be an important underlying condition for development of the echo. Hemorheologic conditions indicated that the shear rate of blood flow in the left atrial cavity was calculated to be low enough for the development of red blood cell aggregation. These conditions suggest that the source of the smoke-like echo might be aggregated cells due to hemostasis in the left atrial cavity. Left atrial thrombi were detected in many patients who had this echo in the left atrial cavity. Although it has not been conclusively determined that the presence of the smoke-like echo is a necessary condition for thrombus formation, this echo appears to be closely related to thrombus formation in the left atrial cavity. It is concluded that the presence of this echo indicates severe left atrial hemostasis and is a warning for thrombus formation.

This article has been cited by other articles:

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]

				E. Donal, J. A. Sallach, R. D. Murray, J. K. Drinko, S. E. Jasper, J. D. Thomas, and A. L. Klein Contrast-enhanced tissue Doppler imaging of the left atrial appendage is a new quantitative measure of spontaneous echocardiographic contrast in atrial fibrillation Eur J Echocardiogr, January 1, 2008; 9(1): 5 - 11. [Abstract] [Full Text] [PDF]

				H. Onozuka, M. Muraki, T. Mikami, T. Yoshimoto, T. Yoshizumi, M. Kitaguchi, T. Sugawara, K. Tokuda, S. Kaneko, T. Kashiwaba, et al. Prevalence and Clinical Importance of Spontaneous Echo Contrast Within the Carotid Artery in Patients With Ischemic Cerebrovascular Disease J. Ultrasound Med., February 1, 2007; 26(2): 169 - 177. [Abstract] [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				M.-C. Chen, C.-J. Wu, H.-K. Yip, H.-W. Chang, C.-Y. Fang, T.-H. Yu, and M. Fu Left Atrial Platelet Activity With Rheumatic Mitral Stenosis: Correlation Study of Severity and Platelet P-Selectin Expression by Flow Cytometry Chest, November 1, 2003; 124(5): 1663 - 1669. [Abstract] [Full Text] [PDF]

				M. Takami, M. Suzuki, K. Sugi, and T. Ikeda Time course for resolution of left atrial appendage stunning after catheter ablation of chronic atrial flutter J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2207 - 2211. [Abstract] [Full Text] [PDF]

				K. Seidl, M. Rameken, A. Drogemuller, M. Vater, A. Brandt, H. Schwacke, C. Bergmeier, R. Zahn, and J. Senges Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion: Final results of the Ludwigshafen Observational Cardioversion Study J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1436 - 1442. [Abstract] [Full Text] [PDF]

				D. Horstkotte, D. Hering, L. Faber, and C. Piper Cardiac morphology and physiology predisposing to thrombus formation Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q8 - Q11. [Abstract] [PDF]

				A Fyrenius, L Wigstrom, T Ebbers, M Karlsson, J Engvall, and A F Bolger Three dimensional flow in the human left atrium Heart, October 1, 2001; 86(4): 448 - 455. [Abstract] [Full Text] [PDF]

				H. B. Erdogan, G. Ipek, K. Kirali, S. N. Omeroglu, M. Guler, O. Isik, and C. Yakut Volume Reduction Procedures in Giant Left Atrium Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 171 - 175. [Abstract] [Full Text] [PDF]

				A. L. Klein, R. D. Murray, and R. A. Grimm Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation J. Am. Coll. Cardiol., March 1, 2001; 37(3): 691 - 704. [Abstract] [Full Text] [PDF]

				A. Bollmann, K.-H. Binias, F. Grothues, K. Sonne, H.-D. Esperer, P. Nikutta, and H. U. Klein Left Atrial Appendage Flow in Nonrheumatic Atrial Fibrillation : Relationship With Pulmonary Venous Flow and ECG Fibrillatory Wave Amplitude Chest, February 1, 2001; 119(2): 485 - 492. [Abstract] [Full Text] [PDF]

				G. Y. H. Lip, A. Rumley, F. G. Dunn, and G. D. O. Lowe Thrombogenesis in Mitral Regurgitation and Aortic Stenosis Angiology, December 1, 1996; 47(12): 1117 - 1125. [Abstract] [PDF]

				R. E. Peverill, R. W. Harper, J. Gelman, T. E. Gan, G. Harris, and J. J. Smolich Determinants of Increased Regional Left Atrial Coagulation Activity in Patients With Mitral Stenosis Circulation, August 1, 1996; 94(3): 331 - 339. [Abstract] [Full Text]

				G. Derumeaux, G. Habib, D. M. Schleifer, P. Ambrosi, J. P. Bessou, D. Metras, A. Cribier, R. Luccioni, R. Soyer, and B. Letac Standard Orthotopic Heart Transplantation Versus Total Orthotopic Heart Transplantation : A Transesophageal Echocardiography Study of the Incidence of Left Atrial Thrombosis Circulation, November 1, 1995; 92(9): 196 - 201. [Abstract] [Full Text]

				J.-J. Monsuez, M. Janier, A. N. Van-Cao, and J.-R. Le Gall Absence of Enhancement of Spontaneous Echocardiographic Contrast by Thrombocytosis in a Patient with Left Ventricular Aneurysm, Primary Thrombocythemia, and von Recklinghausen Neurofibromatosis: A Case Report Angiology, August 1, 1993; 44(8): 651 - 654. [Abstract] [PDF]

				U.U. Babic, Z. Popovic, M. Vucinic, Z. Djurisic, P. Pejcic, and S. Grujicic Selective Coronary Angiography Versus Two-Dimensional Echocardiography for Diagnosis of Left Atrial Thrombi Angiology, November 1, 1991; 42(11): 889 - 898. [Abstract] [PDF]