TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF CARDIOVASCULAR SOURCES OF PERIPHERAL VASCULAR EMBOLISM

The purpose of this study was to determine the impact of transesophage al echocardiography (TEE) on the management of patients with periphera l vascular emboli. We prospectively evaluated the role of TEE in 15 pa tients with documented peripheral emboli and no evidence of occlusive peripheral vascular disease. The patients were divided in two groups f or analysis: group 1 (n = 8) had no clinical evidence of heart disease and group 2 (n = 7) had clinically significant heart disease. TEE pro vided information regarding the source of embolism in four (50%) patie nts in group 1, and these findings significantly affected the manageme nt of ail. Three patients underwent thoracic surgery to remove the sou rce of embolism (aortic valve mass in one and a thrombus in the descen ding thoracic aorta in two); the other patient was treated with thromb olytic agents. TEE findings had high diagnostic value in all patients in group 2, but the results had a possible effect on clinical manageme nt in only two of these patients. TEE provides diagnostic information in most patients with peripheral vascular emboli and this information has a significant influence on management, particularly in those witho ut clinically evident heart disease. TEE should be performed in all pa tients with documented peripheral embolism.