Course of valvular strands in patients with stroke: Cooperative study withtransesophageal echocardiography

Background Native valve strands might be related to the acute stage of thro mbosis or might suggest a long-term valvular change. We aimed to estimate c hanges in the strands in patients with stroke through a serial transesophag eal echocardiographic (TEE) study. Methods and Results A study was conducted among patients who were referred for TEE for stroke or cardiac pathology. Patients had TEE examinations with a 5-MHz multiplane TEE probe. Echocardiography was repeated 3 months later in patients with stroke. TEE was performed in 180 patients admitted to car diology units and in 160 patients referred to neurology units. Among 34 pat ients with valvular strands, 30 were referred to neurology for stroke, wher eas 4 patients were admitted to cardiology (18.8% versus 2.2%, difference 1 6.5%, 95% confidence interval 10% to 22.9%, P = .001). Strands were located on the mitral valve in 16 patients, the aortic valve in 6 patients, and bo th left heart valves in 8 patients. Among the 38 valves with strands, 17 (4 4.7%) were morphologically normal, 4 (10.5%) were thickened, 7 (18.4%) were redundant and 10 (26.3%) had both abnormalities. TEE showed other abnormal ities in 16 (53.3%) patients, whereas 14 patients had only strands. Twenty- six (86.6%) patients had a second TEE study 3 months later. Strands were no t found in 4 (15.4%) patients (95% confidence interval 4.3% to 34.9%). Conclusions Valvular thickening or redundancy may predispose valves to stra nd formation. Native valve strands usually persist and thus reflect a chron ic valvular change.