TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE I NVESTIGATION OF SYSTEMIC EMBOLISMS - RESULT OF 451 CASES

In order to compare the respective values of transoesophageal and tran sthoracic echocardiography in the investigation of systemic embolic ev ents, 451 consecutive patients (average age 60 +/- 15 years) presentin g either with a cerebral ischaemic event (n = 401) or a peripheral art erial embolism (n = 50), were examined. One hundred and ninety eight p atients had documented cardiac disease and/or atrial fibrillation ; 25 3 patients had no previous cardiovascular history. Transcesophageal ec hocardiography revealed a possible cardiac embolic lesion in 37 % of p atients compared with 11 % by transthoracic echocardiography (p < 0.00 1). In those patients with previous cardiac disease, transcesophageal echocardiography was contributory in 50 % of cases compared with 27 % of cases in patients with no previous cardiac disease (p < 0.001), whe reas transthoracic echocardiography was only contributory in 12 % and 9.8 % of cases, respectively. Transesophageal echocardiography was mor e 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), i nteratrial septal aneurysm (6.4 % vs 1.9 %, p < 0.001), mitral valve p rolapge (5.3 % vs 2.8 %, p < 0.01). Moreover, irregular atheromatous p laques in the thoracic aorta could only be visualised by transoesophag eal echocardiography (9 % of cases). This study underlines the superio rity of transcrsophageal echocardiography over transthoracic echocardi ography in the investigation of systemic embolic events. Transoesophag eal echocardiography is even more contributory in patients with a hist ory of cardiac disease.