FREQUENCY OF DEEP-VEIN THROMBOSIS IN PATIENTS WITH PATENT FORAMEN OVALE AND ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK

To evaluate the additional value of transesophageal (TEE) compared wit h transthoracic (TTE) echocardiography and the role of patent foramen ovale (PFO) and deep vein thrombosis in the work-vp of embolic events, patients with presumed cardiac embolic stroke or transient ischemic a ttack (neurovascular etiology was excluded) were prospectively studied by transthoracic and transesophageal contrast echocardiography. If PF O was detected echocardiographically, PFO size was assessed semiquanti tatively and phlebography of both legs was performed. Two hundred fort y-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 potent ial cardiac sources in 52 patients with negative TTE examination and w as significantly superior compared with TTE for identifying left atria l thrombi, spontaneous echo contrast, PFO, atrial septal aneurysm, and atheroma of the ascending aorta. In patients with a positive TTE, add itional diagnostic information by TEE was found in only 6 patients and did not change therapy. Phlebography was performed in 53 patients wit h PFO and revealed deep vein thrombosis in 5 patients (9.5%); all had medium or large PFOs. Thus, in patients with cerebral ischemia of susp ected cardiogenic origin and a normal TTE examination, TEE detects pot ential causes of embolism in 31% of patients and is therefore of diagn ostic relevance. Conversely, in the presence of a diagnostic TTE an ad ditional TEE confers only marginal diagnostic benefit. Deep venous thr ombosis was detected in nearly 10% of patients with PFO as the sole id entifiable cardiac risk factor. Given that in 4 of 5 patients deep vei n thrombosis was clinically silent, phlebography should be performed i n patients with medium or large interatrial shunts if paradoxical embo lism is suspected. (C) 1997 by Excerpta Medica, Inc.