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(Stroke. 1996;27:1183-1186.)
© 1996 American Heart Association, Inc.

Articles

Mitral Valve Strands in Patients With Focal Cerebral Ischemia

Frank D. Tice, MD; Andrew P. Slivka, MD; Elizabeth T. Walz, MD; David A. Orsinelli, MD Anthony C. Pearson, MD

the Departments of Internal Medicine and Neurology, Ohio State University (Columbus).

Correspondence to Frank D. Tice, MD, 6th Floor Means Hall, 1654 Upham Dr, Columbus, Ohio 43210. E-mail tice.2@osu.edu.

Background and Purpose Filamentous strands attached to the mitral valve are a recently described finding in occasional patients undergoing transesophageal echocardiography (TEE), but the frequency and clinical significance of these strands remain poorly defined. The purpose of the present study was to review the prevalence of mitral valve strands in patients undergoing TEE examination and to explore the relation of these strands to cardioembolic cerebral ischemia.

Methods All patients with native mitral valves referred for clinically indicated TEE over a 2-year period at our institution were evaluated for the presence of mitral valve strands (defined as highly mobile filamentous masses <1 mm thick attached to the atrial surface of mitral leaflets).

Results Of 968 study patients, mitral valve strands were identified in 22 individuals (2.3%). Mitral valve strands were significantly more common in patients referred for TEE as a result of a recent ischemic cerebrovascular event compared with patients referred for other study indications (6.3% versus 0.3%, respectively; P<.00001). Among patients 50 years of age with likely cardioembolic stroke or transient ischemic attack, 16% were found to have mitral valve strands on TEE examination. In 9% of these young patients, no other TEE finding associated with cardioembolic risk was present.

Conclusions Filamentous strands attached to the mitral valve appear to represent another risk factor for embolic cerebral ischemia, particularly in patients 50 years of age.

Key Words: echocardiography, transesophageal • mitral valve • risk factors • stroke assessment

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