Millaire A, Goullard L, Chammas E, de Groote P, Houdas Y, Ducloux G
Service de Cardiologie, Hôpital Cardiologique de Lille.
Ann Cardiol Angeiol (Paris). 1993 Jun;42(6):317-23.
Ischemic cerebrovascular accidents are classically attributed to an embolism of cardiac origin in 15% of cases. This longstanding concept is questioned by trans-esophageal echocardiography (TEE). The incidence of anomalies which could be the origin of a cerebral embolism involves more than 50% of cases in certain series. The superiority of TEE over trans-thoracic echocardiography (TTE) emerges in particular when certain abnormalities such as an intra-atrial thrombus, spontaneous atrial contrast, an intra-aortic atherosclerotic plaque, a patent foramen ovale or an aneurysm of the inter-atrial septum are sought. The high incidence of such abnormalities in a population having sustained an ischemic cerebrovascular accident is not sufficient to establish a cause-and-effect relationship between the abnormality and the cerebral event. Certain abnormalities are commonly associated with each other or with emboligenic arrhythmias (atrial fibrillation). Studies hence remain required to determine the respective responsibilities of these various abnormalities and stratify their embolic risk by defining certain risk factors. While awaiting the result of such studies, it would seem valid to suggest the more routine use of TEE in the investigation of ischemic cerebrovascular accidents in young patients free of clinically obvious heart disease, and this regardless of the result of TTE.
缺血性脑血管意外在15%的病例中传统上被归因于心脏来源的栓塞。经食管超声心动图（TEE）对这一长期存在的概念提出了质疑。在某些系列研究中，可能是脑栓塞起源的异常发生率超过50%。当寻找某些异常情况，如心房内血栓、自发性心房显影、主动脉内动脉粥样硬化斑块、卵圆孔未闭或房间隔瘤时，TEE相对于经胸超声心动图（TTE）的优势尤为明显。在发生缺血性脑血管意外的人群中，此类异常的高发生率不足以确立异常与脑部事件之间的因果关系。某些异常情况通常相互关联，或与致栓性心律失常（心房颤动）相关。因此，仍需要进行研究以确定这些各种异常的各自责任，并通过定义某些危险因素来分层它们的栓塞风险。在等待此类研究结果期间，建议在对无临床明显心脏病的年轻患者进行缺血性脑血管意外调查时更常规地使用TEE，无论TTE结果如何，这似乎是合理的。
