Transesophageal Echocardiography

Daniel, Werner G.; Mügge, Andreas

doi:10.1056/nejm199505113321906

Cited by 155 publications

(89 citation statements)

References 153 publications

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“…Such a discrepancy could depend on the different age of the patients under investigation. There is compelling evidence that TEE is more sensitive than TTE (60 vs. 15%) for identifying PCSE [24, 25]. These figures are consistent with the estimates of the present study (68 vs. 22%).…”

Section: Discussionsupporting

confidence: 83%

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Musolino¹,

Spina²,

Granata

et al. 2003

Cerebrovasc Dis

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Background: A few studies have comprehensively assessed the epidemiology, aetiology, prognosis, and secondary prevention of ischaemic stroke in young adults. To gain further information on this field, we have prospectively studied a hospital-based series of young adults with a first-ever episode of cerebral ischaemia (CI). Methods: Sixty consecutive patients aged 17–45 with ischaemic stroke (55 patients) or transient ischaemic attack within 24 h before hospital admission were recruited and investigated by a standardized rigorous protocol. The patients were followed up for ≧1 year after hospital discharge. Arbitrary doses of aspirin 100 mg/d or ticlopidine 250 mg b.i.d. in case of intolerance to aspirin were given for the secondary prevention. Adjusted-dose oral anticoagulation (INR target 2.5) was used in the presence of cardioembolism or hypercoagulable states. Endpoints included the residual disability, rated by modified Rankin Scale (RS) and Barthel Index (BI), and poststroke recurrence. Results: CI was associated with two or more risk factors in 61.6% of patients. Cigarette smoking was more frequently associated with male gender (p < 0.05) and migraine history with female sex (p < 0.05). The atherothrombotic diagnostic subtype and the subtype from ‘other cause’ predominated significantly among patients ≧35 years old (p < 0.05) and <35 years (p < 0.025), respectively. The ‘other cause’ subset was more frequent in female gender (p < 0.05). Transoesophageal echocardiography (TEE) detected potential cardiac sources of emboli (PCSE) at an extent 3 times higher (p < 0.0001) than transthoracic echocardiography. Congenital heart defects were nearly threefold more frequent than acquired ones, with a prevalence of patent foramen ovale. At a mean of 6.1 ± 2.6 years (confidence interval 5.4 to 6.8), follow-up data were available for only 54 patients, since five patients were lost and one died in the acute phase. Poststroke recurrence rate was low (7.4%) and no event was fatal. General handicap was severe to moderately severe (RS>3) in 11% of the patients, slight to moderate (1≧RS≤3) in 59% and absent in 30% (RS = 0). Functional disability was relatively low with 50% of the patients independent (BI ≧95), 38.9% partially dependent (BI 60 to 86), and 11.1% fully dependent (BI <60). Thirty-seven (68.5%) patients returned to work, although adjustments (other job or part-time employment) were necessary for 10 out of them (27%). Conclusions: The present study, though limited by the relatively small number of subjects, suggests that the overall prognosis of ischaemic stroke in young adults is good. We strongly recommend TEE in all patients with ischaemic stroke as an essential tool to increase the detection of PCSE and make the therapeutic approach more efficient.

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Section: Discussionsupporting

confidence: 83%

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Musolino¹,

Spina²,

Granata

et al. 2003

Cerebrovasc Dis

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“…Si l'anamnèse, l'examen cardiaque clinique et TDM ou IRM évoquent en premier lieu une embolie cardiogène, on procédera à des examens complémentaires moyennant une échocardiographie trans-thoracique ou trans-oesophagienne [1]. Par rapport à l'approche trans-thoracique l'échocardiographie trans-oesophagienne est plus sensible en particulier concernant une pathologie atriale ou valvulaire ou pour des plaques de l'arc aortique.…”

Section: Marche à Suivre Après Les Premières Heures (Et éGalement Aprunclassified

“…L'échocardiographie trans-thoracique permet une bonne évaluation du ventricule gauche et de la fonction des prothèses valvulaires, par contre, l'ETT multiplanéaire permet de visualiser l'appareil valvulaire, les oreillettes et l'auricule gauche, le septum inter-atrial et l'aorte thoracique avec une résolu-tion beaucoup plus précise. L'exclusion de source cardiaque emboligène est l'indication la plus fréquente pour procéder à une ETO chez 35 à 55% de tous les patients [18].…”

Section: L'échocardiographie (Figure 7)unclassified

Attitude pratique en cas d’un accident vasculaire cérébral: Diagnostic

2000

Schweiz Ärzteztg

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“…Transesophageal echocardiography (TEE) has emerged as the most sensitive method for the detection of atrial masses [3, 4], with a high diagnostic accuracy when compared to operative findings [5, 6]. Because TEE also images the cardiac valves and ventricles, it is felt to provide the best single test for evaluation of the embolic potential of the heart [3, 6].…”

Section: Introductionmentioning

confidence: 99%

“…Because TEE also images the cardiac valves and ventricles, it is felt to provide the best single test for evaluation of the embolic potential of the heart [3, 6]. …”

Section: Introductionmentioning

confidence: 99%

In vivo Magnetic Resonance Imaging and Surgical Histopathology of Intracardiac Masses: Distinct Features of Subacute Thrombi

et al. 2001

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We evaluated intracardiac masses in vivo, in situ and histologically to determine tissue properties revealed by magnetic resonance (MR) imaging. In 15 consecutive patients scheduled for cardiotomy, the cardiac chambers were studied preoperatively with MR imaging and echocardiography. Visual examination of one or more chambers was performed during cardiotomy for mitral valve replacement, aneurysmectomy, atrial septal repair and atriotomy. Six thrombi (1 atrial appendage, 5 ventricular) and 2 atrial myxomas were removed and subjected to histological analysis. All masses were detected preoperatively by MR imaging. The smallest was a subacute 3-mm mural clot in the left ventricle and was undetected by transesophageal and transthoracic echocardiography. The 3 subacute clots had homogeneously low MR signals, did not enhance with gadolinium and exhibited magnetic susceptibility effects; histopathology confirmed these clots to be avascular and laden with dense iron deposition related to hemoglobin breakdown products. The 3 organized clots had intermediate and heterogeneous MR signals and multiple areas of gadolinium enhancement. The 2 myxomas had low MR signals and gadolinium enhancement in the core and septal attachment; these areas had dense neovascular channels. Subacute thrombi appear to have MR features that are distinct from organized thrombi and myxomas, and MR images of subacute thrombi contrast sharply with normal cardiac structures, enabling detection of thin mural clots that may be echographically occult. These findings may be of value, because a subacute clot may be more likely than an organized thrombus to give rise to an embolus.

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Transesophageal Echocardiography

Cited by 155 publications

References 153 publications

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Attitude pratique en cas d’un accident vasculaire cérébral: Diagnostic

In vivo Magnetic Resonance Imaging and Surgical Histopathology of Intracardiac Masses: Distinct Features of Subacute Thrombi

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