Dr.S.Venkatesan MD

Hurricanes  are ocean’s  reaction to the climate change  especially  in subtropics.  When low pressure  zones  form over the ocean surface  the nidus for hurricane is sown .It   gradually intensifies to form deadly cyclones.The maximum damage is done when it  encounters the land . The following image  depicts how the hurricane Katrina caused havoc in the southern US coastline .

Hurricane katrina .Click to view animation

When the human blood stream is interrupted  by any pathological hurdle  it  gets  agitated . It encounters both turbulence as well as  a  slow flow phenomenon . Virchow taught us centuries ago  , slow flow , a vessel wall defect and  an abnormal blood combine to create a  clot. This is what happens in mitral stenosis . What appears as a mild turbulence  gathers momentum  and becomes a storm .The eye of the storm has the  least velocity and it  forms  the core of the future clot.

Left atrial strom visualised by TEE

What is left atrial jelly ?

A  pre- clot stage with impending clot formation may be referred to as a jelly . The exact  duration for  a contrast to get converted to clot is not known.It depends host of factors from hemodynamic and rheological factors. It  is  believed every clot   must be preceded by at least a brief period of auto contrast.

Is there a intrinsic  defect in blood in those patients who have spontaneous contrast ?

Yes , there has been  excess  fibrinogen  in these  patients. http://www.ncbi.nlm.nih.gov/pubmed/11744141

Can we dissolve  spontaneous  contrast ?

It  may be  possible with intensive anti coagulation. Ultrasonic dessication may be a modality that could be developed in future.

Is  the presence of  spontaneous echo contrast a contraindication to do PTMC/CMC ?

Some centers do believe so. Currently intensive anticogulation ,   meticulous preparation   with  special  precautions  during procedure will reduce embolic  manifestation.

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