Chammas E, Khoury J, Ghanem G, Tarcha W, Jazra C, Germanos S, Abou Jaoude F
Service de Cardiologie, Hôpital Rizk, Beyrouth, Liban.
J Med Liban. 1998 Jul-Aug;46(4):194-8.
Ischemic cerebro-vascular events are in 15% of cases secondary to a cardiac embolus. The prevalence of echocardiographic anomalies, susceptible of being at the origin of a cerebral embolus may reach 50%. Transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) in the detection of a thrombus of the left atrial appendage, spontaneous echocontrast, intra-aortic atherosclerotic plaque lesion, patent foramen ovale or an atrial septal aneurysm. The high prevalence of these anomalies in a population who presented an ischemic cerebrovascular accident does not suffice to establish a causal relationship between the anomaly and the cerebral event. Further studies seem to be necessary to establish the responsibility of these different anomalies and determine their embolic risk, by defining certain risk factors. Pending the results of such studies, TEE should be indicated more systematically in the case of an ischemic cerebrovascular accident of the young patient without a clinically evident cardiopathy, independently of the results of TTE.
缺血性脑血管事件在15%的病例中继发于心脏栓子。可能成为脑栓子来源的超声心动图异常的患病率可达50%。在检测左心耳血栓、自发回声增强、主动脉内动脉粥样硬化斑块病变、卵圆孔未闭或房间隔瘤方面，经食管超声心动图（TEE）优于经胸超声心动图（TTE）。在出现缺血性脑血管意外的人群中，这些异常的高患病率不足以确立异常与脑事件之间的因果关系。似乎有必要进行进一步研究，通过确定某些危险因素来确定这些不同异常的责任并确定其栓塞风险。在这些研究结果出来之前，对于没有临床明显心脏病的年轻患者发生缺血性脑血管意外的情况，无论TTE结果如何，都应更系统地进行TEE检查。
