title: Identifying a cardiac source of embolism by transesophageal echocardiography: review of a 12-year experience.
abstract: BACKGROUND
  Peripheral embolism is frequently related to a cardiac source of embolism. Transesophageal echocardiography (TEE) is a useful tool for identifying such sources.
  
  
  OBJECTIVE
  Our laboratory has gained wide experience in TEE, with a large number of exams performed to search for a cardiac source of embolism. We therefore thought it would be useful to present our experience in the last 12 years following the introduction of the technique.
  
  
  METHODS
  This was a retrospective study of 1110 consecutive patients undergoing TEE to search for a cardiac source of embolism, after an embolic event and a transthoracic echocardiogram.
  
  
  RESULTS
  The patients' mean age was 53 +/- 14 years, 52% male. There was peripheral embolism in 5% of cases and cerebral embolism in the remainder. The exam identified a potential embolic source in 35.6% of cases, the most frequent diagnoses being intracardiac shunt at the atrial level (9.5%), atrial septal aneurysm (ASA) (6.6%), intracardiac thrombi (6.4%) and atherosclerotic plaques in the thoracic aorta (9.6%). The presence of ASA was frequently associated with patent foramen ovale (27%), which was more frequent in younger patients. Overall, we identified a cardiac source of embolism more often in elderly patients, with a predominance of atherosclerotic plaques in the aorta. ETE was more frequently diagnostic in patients with peripheral embolism, but there were no differences in terms of etiology.
  
  
  CONCLUSIONS
  TEE is very useful to search for cardiac sources of embolism, especially in younger patients, in whom causes potentially treatable surgically or percutaneously can be identified. In elderly patients, therapeutic strategy will probably not be changed by the findings (mostly thrombi and atherosclerotic plaques). The presence of ASA and embolic events makes it essential to perform a thorough search by TEE for intracardiac shunts, which are frequently associated.
authors.affiliation: Laboratório de Ecocardiografia, Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. ana_timoteo@yahoo.com
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Timóteo
authors.forename: Luísa Moura
authors.initials: LM
authors.lastname: Branco
authors.forename: Ana
authors.initials: A
authors.lastname: Galrinho
authors.forename: João
authors.initials: J
authors.lastname: Abreu
authors.forename: Ana
authors.initials: A
authors.lastname: Leal
authors.forename: Ana
authors.initials: A
authors.lastname: Santana
authors.forename: Lídia
authors.initials: L
authors.lastname: Sousa
authors.forename: Carlos Spencer
authors.initials: CS
authors.lastname: Salomão
authors.forename: Rui
authors.initials: R
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors