Transesophageal echocardiography in the definition of intracardiac sources of emboli in patients with recent ischemic stroke.
Using both transthoracic and transesophageal echocardiography we studied 13 consecutive patients with recent CT-proven ischemic stroke in which a carotid arteries high-resolution ultrasound study failed to detect thrombosis or other relevant atherosclerotic lesions in the pertinent arteries. The mean age was 53 years (range: 36-65). Two patients exhibited clinical signs of cardiac disease at physical examination i.e. absolute arrhythmia, mitral stenosis. Conventional transthoracic echocardiography allowed the detection of potential cardiac sources of emboli in 2/13 patients (15.4%): mitral stenosis in one patient and dilated cardiomyopathy in another. Transesophageal echocardiography was successfully performed without general sedation in all patients. Potential cardiac sources of emboli could be identified in 12/13 patients (92%). Left atrial thrombi were found in 3 patients: in two of them they were associated with rheumatic alterations of mitral valve leaflets; in the third patient a small thrombus was located inside a normal-sized, poorly contracting left atrial appendage. Left atrial appendage could be clearly visualized in all patients. A myxoid degeneration of a prolapsing mitral leaflet was found in 3 patients and an interatrial septum aneurysm in 2. Furthermore, at color-flow Doppler and contrast transesophageal echocardiography, 7 patients (54%) showed patency of the foramen ovale. In 5 of these patients paradoxical right to left shunting after cough or Valsalva manoeuvre could be evidenced. With reference to 11/13 patients with no clinical signs of cardiac disease at physical examination, subclinical potential cardiac sources of emboli could be detected at conventional transthoracic echocardiography in 1 and at transesophageal echocardiography in 10 patients (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Tramarin
R
R
Divisione di Cardiologia, Fondazione Clinica del Lavoro, Pavia, Italy.
Torbicki
A
A
Franchini
M
M
Forni
G
G
Febo
O
O
Gibellini
R
R
Pistarini
C
C
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging; D004452:Echocardiography; D004947:Esophagus; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology*; D008875:Middle Aged; D013927:Thrombosis / Q000000981:diagnostic imaging*