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Enhanced Detection of Intracardiac Sources of Cerebral Emboli by Transeophageal Echocardiography
Stroke 22:734-739, Lee,R.J.,et al, 1991
See this aricle in Pubmed
Article 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 librosis that can serve as a nidus for thrombus formation.We detected no unexpected left ventricular thrombosis 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.
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atrial enlargement
atrial fibrillation
cerebral embolism
cerebral embolism,cardiac origin
cerebrovascular accident
echocardiogram
echocardiogram,transesophageal
embolism
mitral valve lesion
transient ischemic attack
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