Lee R J, Bartzokis T, Yeoh T K, Grogin H R, Choi D, Schnittger I
Division of Cardiovascular Medicine, Stanford University Medical Center, CA 94305.
Stroke. 1991 Jun;22(6):734-9. doi: 10.1161/01.str.22.6.734.
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.
我们对50例近期因栓塞性病因发生短暂性脑缺血发作或中风而住院的患者进行了经食管超声心动图检查，以确定经食管超声心动图在检测可能的心内栓塞源方面是否比经胸超声心动图更敏感。50例经胸超声心动图未发现潜在栓塞源的患者中，有26例进行了经食管超声心动图检查，结果显示至少存在一种心内异常。经食管超声心动图发现的异常包括：50例患者中有5例左心房或左心耳有血栓，4例有卵圆孔未闭，9例有自发显影。在50例无其他栓塞源的患者中，有11例在二尖瓣上发现了高度活动的丝状条索，此前未见相关描述。这些二尖瓣回声条索可能代表可作为血栓形成病灶的裂开表面或纤维化。我们未检测到意外的左心室血栓或左心房黏液瘤。与经食管超声心动图检查结果呈阳性可能性显著相关的因素包括左心房扩大、心房颤动以及二尖瓣钙化或增厚。我们的研究表明，在调查潜在的心内栓塞源时，经食管超声心动图是对经胸超声心动图的一项有价值的补充。
