New York University Langone Medical Center, New York, New York.
Duke University Health System, Durham, North Carolina.
J Am Soc Echocardiogr. 2016 Jan;29(1):1-42. doi: 10.1016/j.echo.2015.09.011.
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
来自心脏或胸主动脉的栓塞常导致短暂性脑缺血发作、中风或外周动脉阻塞等临床显著的发病率和死亡率。经胸和经食管超声心动图是评估、诊断和管理中风、全身性和肺栓塞的关键诊断方式。本文件提供了全面的美国超声心动图学会指南，用于评估心脏栓塞源的超声心动图。它描述了中风和全身性栓塞的一般机制；心脏和主动脉源在中风、全身性和肺栓塞中的具体作用；超声心动图在评估、诊断和管理心脏和主动脉栓塞源中的作用，包括对比增强和 3D 超声心动图的增值价值；以及简要描述替代成像技术及其在评估心脏栓塞源中的作用。为每个栓塞源类别提供了具体的指南，包括左心房和左心耳、左心室、心脏瓣膜、心脏肿瘤和胸主动脉。此外，还有关于肺栓塞以及与心血管手术和经皮操作相关的栓塞的建议。该指南还包括一个专门针对儿科人群心脏栓塞源的部分。
