Stroke, Vol 21, 560-565, Copyright © 1990 by American Heart Association
G Pop, GR Sutherland, PJ Koudstaal, TW Sit, G de Jong and JR Roelandt
Using both precordial and transesophageal echocardiography, we studied 72
consecutive patients with a recent unequivocal transient ischemic attack or
nondisabling stroke to determine the relative value of the two techniques
for detecting potential intracardiac sources of cerebral emboli. Group 1 (n
= 53) patients had no clinical cardiac abnormality, and group 2 (n = 19)
patients had abnormal cardiac findings upon clinical examination. In group
1, precordial echocardiography detected an abnormality in only one patient
(aortic valve thickening) but transesophageal echocardiography defined
morphologic abnormalities in five patients (one with a left atrial
appendage mass lesion, one with aortic dissection, one with mitral valve
prolapse, one with a mitral leaflet mass lesion, and one with aortic valve
thickening). In group 2, both precordial and transesophageal
echocardiographic studies were normal in 13 patients, while both were
abnormal in the remaining six patients. Five of these six patients had
pathologic left atrial and/or left ventricular dilatation, but only
transesophageal echocardiography defined a left atrial appendage thrombus
in two of the six. The sixth patient had mitral chordal rupture, seen on
both precordial and transesophageal echocardiography. In addition, in 32 of
the 72 patients transesophageal echocardiography identified widespread
thoracic aortic atherosclerotic plaques not visualized by precordial
echocardiography. We conclude that transesophageal echocardiography
significantly increases the yield in visualizing potential intracardiac
sources of emboli compared with precordial echocardiography. However, the
precise clinical value of the former in the management of such patients
requires further study as the number of abnormal transesophageal
echocardiographic findings is not high and a causative relation with
transient ischemic attacks cannot be proven.
ARTICLES
Transesophageal echocardiography in the detection of intracardiac embolic sources in patients with transient ischemic attacks
Department of Cardiology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
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