title: The impact of spontaneous echocardiographic contrast in patients with left atrial enlargement undergoing cardiac valvular surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of either left atrial or aortic spontaneous echocardiographic contrast (SEC), as identified on intraoperative transesophageal echocardiography, on short-term morbidity and mortality in patients with left atrial enlargement undergoing cardiac valvular surgery.
  
  
  METHODS
  Retrospective and observational.
  
  
  METHODS
  Single-center, university teaching hospital.
  
  
  METHODS
  The authors identified 197 patients (105 males and 92 females; mean age, 68 +/- 14 years) with left atrial enlargement who underwent surgical intervention for valvular heart disease from January 1, 2004 to January 1, 2005.
  
  
  RESULTS
  Of the total population, 40 patients (20.3%) showed left atrial SEC, and 10 patients (5.1%) showed aortic SEC. On multivariate analysis, increasing left atrial size and the absence of mitral regurgitation were independent predictors for the presence of left atrial SEC. On multivariate analysis, the presence of atrial fibrillation and a dilated descending aorta were predictive of aortic SEC. Although the identification of left atrial SEC was an echocardiographic marker of an increased risk for thromboembolic events postoperatively, this finding did not hold true for the presence of aortic SEC.
  
  
  CONCLUSIONS
  Intraoperative identification of left atrial dilatation or aortic dilatation is predictive of SEC in the left atrium or descending aorta, respectively. The identification of left atrial SEC is an echocardiographic marker of an increased risk for thromboembolic events in this high-risk population.
authors.affiliation: Department of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. djassal@sbgh.mb.ca
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Desai
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.forename: Edwin
authors.initials: E
authors.lastname: Avery
authors.forename: Gus J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Agnihotri
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control