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Stroke, Vol 22, 734-739, Copyright © 1991 by American Heart Association
RJ Lee, T Bartzokis, TK Yeoh, HR Grogin, D Choi and I Schnittger
We performed transesophageal echocardiography in 50 consecutive
hospitalized patients with recent transient ischemic attack or stroke of
embolic origin to determine whether transesophageal echocardiography is
more sensitive than transthoracic echocardiography in detection of possible
intracardiac sources of embolism. Twenty-six of 50 patients with a negative
transthoracic echocardiogram for potential source of emboli had a
transesophageal echocardiography study that demonstrated at least one
intracardiac abnormality. Abnormalities noted by transesophageal
echocardiography included five of 50 patients with either a left atrial or
left atrial appendage clot, four patients with a patent foramen ovale, and
nine patients with spontaneous echocardiographic contrast. In 11 of 50
patients with no other source of embolism, we found highly mobile
filamentous strands on the mitral valve, which have not been described
previously. These mitral valve echo strands may represent a fissured
surface or fibrosis that can serve as a nidus for thrombus formation. We
detected no unexpected left ventricular thrombus or left atrial myxoma.
Factors significantly associated with a greater likelihood of a positive
transesophageal echocardiography study included left atrial enlargement,
atrial fibrillation, and a calcified or thickened mitral valve. Our study
suggests that transesophageal echocardiography is a valuable addition to
transthoracic echocardiography in investigating potential intracardiac
sources of embolism.
ARTICLES
Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography
Division of Cardiovascular Medicine, Stanford University Medical Center, CA 94305.
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