Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography.

Abstract

We performed transesophageal echocardiography in 50 consecutive hospitalized patients with recent transient ischemic attack or stroke of embolic origin to determine whether transesophageal echocardiography is more sensitive than transthoracic echocardiography in detection of possible intracardiac sources of embolism. Twenty-six of 50 patients with a negative transthoracic echocardiogram for potential source of emboli had a transesophageal echocardiography study that demonstrated at least one intracardiac abnormality. Abnormalities noted by transesophageal echocardiography included five of 50 patients with either a left atrial or left atrial appendage clot, four patients with a patent foramen ovale, and nine patients with spontaneous echocardiographic contrast In 11 of 50 patients with no other source of embolism, we found highly mobile filamentous strands on the mitral valve, which have not been described previously. These mitral valve echo strands may represent a fissured surface or fibrosis that can serve as a nidus for thrombus formation. We detected no unexpected left ventricular thrombus or left atrial myxoma. Factors significantly associated with a greater likelihood of a positive transesophageal echocardiography study included left atrial enlargement, atrial fibrillation, and a calcified or thickened mitral valve. Our study suggests that transesophageal echocardiography is a valuable addition to transthoracic echocardiography in investigating potential intracardiac sources of embolism. (Stroke 1991^2:734-739)

Nonbacterial Thrombotic Endocarditis in Cancer Patients: Pathogenesis, Diagnosis, and Treatment

“…Despite the invasive nature of transesophageal echocardiography (TEE), TEE is thought to be more sensitive in detecting valvular vegetations than transthoracic echocardiography (TTE) and is thus the preferred diagnostic test for this condition. The potential value of TEE in diagnosing NBTE was illustrated in a series of 51 consecutive cancer patients with cerebrovascular events who were referred for TEE [35]. Almost one half of the patients had a definite cardiac source of embolism.…”

A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale.

“…4 In the case of PFO, bubbles passing from the right to the left atrium can be observed. 5 Conventional transthoracic color Doppler sonography usually fails because the Valsalva maneuver, which is necessary to create the right-to-left shunt, leads to a decrease in image quality. TEE requires considerable technical and personal prerequisites and cannot be applied immediately after stroke onset in the majority of stroke victims.…”

Patient with patent foramen ovale and thrombophilia, after ischemic stroke, acute coronary syndrome and pulmonary embolism (RCD code: IV-2B.O)

“…Several modalities have been adopted for this purpose including transthoracic echocardiography (TTE), TEE, TCD or transmitral Doppler (TMD). TEE has evolved to be the "gold standard" method and as such is most commonly used [12,13]. It has the advantage of visualizing the site of the right-to-left shunt together with its mor- phology and hemodynamic significance.…”