HOW INQUIRE CARDIAC ORIGIN TO AN ARTERIAL EMBOLIC EVENT

Owing to a very high-definition image, transesophageal echocardiograph y (TEE) allows screening lesions that are not detected by other examin ation techniques. Its superiority is especially obvious in the analysi s of the atrial structure of the mitral valve and of the interatrial s eptum, therefore for the analysis of structures that are most commonly involved in embolic strokes. After history taking, a clinical examina tion, and the analysis of the electrocardiogram and of the thoraxic X- rays, two cases are possible: 1) There is an indisputable emboligenic heart disease: atrial fibrillation (AF), mitral stenosis, bacterial en docarditis, or a valvular prosthesis. Systematic transthoracic cardiac ultrasonography (TTE) completes this assessment. 2) When the initial findings are negative, ETT being included in the assessment, the ident ification of a potential cardiac cause of embolism depends on: the deg ree of investigation implemented: Holter to check for paroxysmal AF, T EE knowing that the diagnostic efficiency of this examination is low w hen the initial assessment is negative; what is selected as an embolig ene cardiac cause. In fact, in addition to commonly recognized causes called major causes, there are so-called minor abnormalities that are still ill-defined but are known to be associated with arterial embolis m. For example, a patent foramen ovale or an aneurysm of the interatri al septum are very easily diagnosed with TEE, but the exact mechanism of embolism and the appropriate therapeutic attitude still remain to b e defined for this type of pathology.