[Contribution of transesophageal ultrasonography in the etiologic evaluation of a systemic embolic accident. Apropos of 451 patients]

Abstract

In order to compare the respective values of transoesophageal and transthoracic echocardiography in the investigation of systemic embolic events, 451 consecutive patients (average age 60 +/- 15 years) presenting either with a cerebral ischaemic event (n = 401) or a peripheral arterial embolism (n = 50), were examined. One hundred and ninety eight patients had documented cardiac disease and/or atrial fibrillation; 253 patients had no previous cardiovascular history. Transoesophageal echocardiography revealed a possible cardiac embolic lesion in 37% of patients compared with 11% by transthoracic echocardiography (p < 0.001). In those patients with previous cardiac disease, transoesophageal echocardiography was contributory in 50% of cases compared with 27% of cases in patients with no previous cardiac disease (p < 0.001), whereas transthoracic echocardiography was only contributory in 12% and 9.8% of cases, respectively. Transoesophageal echocardiography was more sensitive for the diagnosis of intracavitary thrombus (7.5% vs 2.2%, p < 0.001), prosthetic valve thrombosis (2.4% vs 0.6%, p < 0.01), spontaneous contrast in the left atrium (10.8% vs 0%, p < 0.001), interatrial septal aneurysm (6.4% vs 1.9%, p < 0.001), mitral valve prolapse (5.3% vs 2.8%, p < 0.01). Moreover, irregular atheromatous plaques in the thoracic aorta could only be visualised by transoesophageal echocardiography (9% of cases). This study underlines the superiority of transoesophageal echocardiography over transthoracic echocardiography in the investigation of systemic embolic events. Transoesophageal echocardiography is even more contributory in patients with a history of cardiac disease.