Bussière J P, Bonnet D, Renard J L, Monségu J, Plotton C, Duriez P, De Bourayne J, Ollivier J P
Service de Cardiologie, HIA du Val-de-Grâce, Paris.
Ann Med Interne (Paris). 1992;143(1):5-10.
Transesophageal echocardiography (TEE) is a semi-invasive examination that provides better images of the atrium than classical transthoracic echocardiography (TTE) due to the anatomical positioning of the captor and the high frequency Doppler apparatus used. We used TEE and TTE to evaluate the incidence of the cardiac origin of emboli in 46 patients with unexplained stroke or transient ischemic attack (TIA): 23 had documented heart disease (mean age 60 years) and 23 had no cardiac disease (mean age 43 years). Among those with existing heart disease, 4% of the anomalies certainly or probably responsible for the emboli in addition to the underlying cardiopathy were detected by TTE versus 37% by TEE (as compared to values reported in the literature: 25% by TTE and 51% by TEE). In particular, 4 abnormalities were better visualized by TEE: left atrial thrombus, especially those located in the auricle (5 TEE versus 1 TTE); spontaneous contrast showing the swirl of blood stagnating in the dilated left atria of patients with mitral valve disease seen in 7-39% of the TIA by TEE as compared to less than 1% by TTE (3 TEE versus 0 TTE); aneurysm of the interauricular septum (AIAS) observed in 5-16% of the TIA by TEE as opposed to 0-1% by TTE (4 TEE versus 1 TTE); patent foramen ovale (PFO) was noted more frequently following injection of a contrast medium when visualized by TEE (19-22%) than by TTE (6-8%) and can explain the passage of a paradoxical embolus (1 TEE versus 0 TTE). The incidences of left atrial thrombus, AIAS and PFO are well correlated with systemic emboli, especially in young adults having experienced an unexplained TIA without underlying cardiopathy. TEE is an easy-to-use and well tolerated technique for detecting the cardiac origin of emboli in unexplained stroke. Whether to opt for a medical or surgical treatment to avoid recurrences is discussed.
经食管超声心动图（TEE）是一种半侵入性检查，由于探头的解剖位置以及所使用的高频多普勒设备，它能提供比传统经胸超声心动图（TTE）更好的心房图像。我们使用TEE和TTE对46例不明原因的中风或短暂性脑缺血发作（TIA）患者的心脏栓子来源发生率进行评估：23例有确诊的心脏病（平均年龄60岁），23例无心脏病（平均年龄43岁）。在患有现有心脏病的患者中，TTE检测到除潜在心脏病外肯定或可能导致栓子形成的异常情况占4%，而TEE为37%（与文献报道的值相比：TTE为25%，TEE为51%）。特别是，有4种异常情况通过TEE能更好地显示：左心房血栓，尤其是位于心耳的血栓（TEE检测到5例，TTE检测到1例）；自发显影，显示二尖瓣疾病患者扩张的左心房内血液停滞的漩涡，TEE在7% - 39%的TIA患者中可见，而TTE低于1%（TEE检测到3例，TTE检测到0例）；房间隔瘤（AIAS），TEE在5% - 16%的TIA患者中观察到，而TTE为0% - 1%（TEE检测到4例，TTE检测到1例）；注射造影剂后，TEE比TTE更频繁地发现卵圆孔未闭（PFO）（TEE为19% - 22%，TTE为6% - 8%），并且可以解释反常栓子的通过（TEE检测到1例，TTE检测到0例）。左心房血栓、AIAS和PFO的发生率与全身性栓子密切相关，尤其是在无潜在心脏病的不明原因TIA的年轻成年人中。TEE是一种用于检测不明原因中风中栓子心脏来源的易于使用且耐受性良好的技术。文中还讨论了是选择药物治疗还是手术治疗以避免复发。
