[Transesophageal echocardiography in the etiological evaluation of ischemic cerebral vascular accidents. Value in young subjects].
OBJECTIVE
We conducted this study to evaluate the role of transoesophageal echocardiography in the aetiologic diagnosis of ischaemic cerebral vascular events in young subjects.


METHODS
Over a 16-month period, 70 consecutive patients under 55 (mean age 49 years; range 32-55; 34 females, 36 males) underwent transoesophageal echocardiography as part of a complete work-up after a recent (< 1 month) cerebral event considered to be ischaemic in nature. Exclusion criteria were age over 55, vascular stenosis or ulcerated plaque, embologenic heart disease and valve prosthesis. 24-h Holter recordings were also obtained in all patients.


RESULTS
The cerebral event was temporary in 11 subjects and permanent in the other 59. The ischaemic nature of the event was confirmed in all patients with computed tomography or magnetic resonance imagery. All patients were in sinus rhythm at examination and supraventricular paroxysmal arrhythmia was observed in 7 during the Holter recordings. The transoesophageal echocardiography was normal in 37 patients (52%) and pathologic in 33 (48%). The source of the embolus was identified in 4 cases (6%) and the probable cause of the cerebral event was found in 29 (42%). Among the abnormal structures observed were permeable oval foramens, inter-atrial septum aneurysms and plaques on the ascending aorta.


CONCLUSIONS
In our selected population of patients under 55 years of age, transoesophageal echocardiography detected the certain or probable source of the ischaemic cerebral event in 48% of the cases, a diagnostic yield better than most other methods. Nevertheless, there is no known therapeutic response to several of the potential sources of embolus observed.
Service de Cardiologie, Hôpital Pasteur, Nice.
E
E
Ferrari
S
S
Sarzotti
P
P
Gibelin
M H
MH
Mahagne
P
P
Thomas
P
P
Bedoucha
M
M
Baudouy
P
P
Morand
D000328:Adult; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging
Echocardiographie transoesophagienne dans le bilan étiologique des accidents vasculaires cérébraux ischémiques. Intérêt chez les sujets jeunes.