MITRAL-VALVE STRANDS IN PATIENTS WITH FOCAL CEREBRAL-ISCHEMIA

Background and Purpose Filamentous strands attached to the mitral valv e are a recently described finding in occasional patients undergoing t ransesophageal echocardiography (TEE), but the frequency and clinical significance of these strands remain poorly defined. The purpose of th e present study was to review the prevalence of mitral valve strands i n patients undergoing TEE examination and to explore the relation of t hese strands to cardioembolic cerebral ischemia.Methods All patients. with native mitral valves referred for clinically indicated TEE over a 2-year period at our institution were evaluated for the presence of m itral valve strands (defined as highly mobile filamentous masses <1 mm thick attached to the atrial surface of mitral leaflets). Results Of 968 study patients, mitral valve strands were identified in 22 individ uals (2.3%). Mitral valve strands were significantly more common in pa tients referred for TEE as a result of a recent ischemic cerebrovascul ar event compared with patients referred for other study indications ( 6.3% versus 0.3%, respectively; P<.00001). Among patients less than or equal to 50 years of age with likely cardioembolic stroke or transien t ischemic attack, 16% were found to have mitral valve strands on TEE examination. In 9% of these young patients, no other TEE finding assoc iated with cardioembolic risk was present. Conclusions Filamentous str ands attached to the mitral valve appear to represent another risk fac tor for embolic cerebral ischemia, particularly in patients less than or equal to 50 years of age.