Lethen H, Flachskampf F A, Schneider R, Sliwka U, Köhn G, Noth J, Hanrath P
Department of Cardiology, University Hospital of Aachen, Germany.
Am J Cardiol. 1997 Oct 15;80(8):1066-9. doi: 10.1016/s0002-9149(97)00604-8.
To evaluate the additional value of transesophageal (TEE) compared with transthoracic (TTE) echocardiography and the role of patent foramen ovale (PFO) and deep vein thrombosis in the work-up of embolic events, patients with presumed cardiac embolic stroke or transient ischemic attack (neurovascular etiology was excluded) were prospectively studied by transthoracic and transesophageal contrast echocardiography. If PFO was detected echocardiographically, PFO size was assessed semiquantitatively and phlebography of both legs was performed. Two hundred forty-two consecutive patients (153 men, 60 +/- 15 years) were studied. In 197 patients, neuroimaging showed evidence of embolic infarction. TEE identified 138 potential cardiac sources of embolism in 111 patients, compared with 69 by TTE (p <0.01) in 59 patients. TEE detected potential cardiac sources in 52 patients with negative TTE examination and was significantly superior compared with TTE for identifying left atrial thrombi, spontaneous echo contrast, PFO, atrial septal aneurysm, and atheroma of the ascending aorta. In patients with a positive TTE, additional diagnostic information by TEE was found in only 6 patients and did not change therapy. Phlebography was performed in 53 patients with PFO and revealed deep vein thrombosis in 5 patients (9.5%); all had medium or large PFOs. Thus, in patients with cerebral ischemia of suspected cardiogenic origin and a normal TTE examination, TEE detects potential causes of embolism in 31% of patients and is therefore of diagnostic relevance. Conversely, in the presence of a diagnostic TTE an additional TEE confers only marginal diagnostic benefit. Deep venous thrombosis was detected in nearly 10% of patients with PFO as the sole identifiable cardiac risk factor. Given that in 4 of 5 patients deep vein thrombosis was clinically silent, phlebography should be performed in patients with medium or large interatrial shunts if paradoxical embolism is suspected.
为评估经食管（TEE）超声心动图相对于经胸（TTE）超声心动图的附加价值以及卵圆孔未闭（PFO）和深静脉血栓形成在栓塞事件检查中的作用，对疑似心脏栓塞性卒中或短暂性脑缺血发作（排除神经血管病因）的患者进行了经胸和经食管对比超声心动图的前瞻性研究。如果超声心动图检测到PFO，则对PFO大小进行半定量评估，并对双腿进行静脉造影。连续研究了242例患者（153例男性，年龄60±15岁）。197例患者的神经影像学显示有栓塞性梗死证据。TEE在111例患者中识别出138个潜在的心脏栓塞源，而TTE在59例患者中识别出69个（p<0.01）。TEE在52例TTE检查阴性的患者中检测到潜在的心脏源，在识别左心房血栓、自发回声增强、PFO、房间隔瘤和升主动脉粥样硬化方面明显优于TTE。在TTE阳性的患者中，TEE仅在6例患者中发现了额外的诊断信息，且未改变治疗方案。对53例PFO患者进行了静脉造影，5例（9.5%）发现深静脉血栓形成；所有患者均有中或大型PFO。因此，在疑似心源性脑缺血且TTE检查正常的患者中，TEE在31%的患者中检测到潜在的栓塞原因，因此具有诊断意义。相反，在TTE诊断明确的情况下，额外的TEE仅带来边际诊断益处。在以PFO作为唯一可识别的心脏危险因素的患者中，近10%检测到深静脉血栓形成。鉴于5例患者中有4例深静脉血栓形成在临床上无症状，如果怀疑有反常栓塞，对于有中或大型房间隔分流的患者应进行静脉造影。
