Role of transesophageal echocardiography in detecting cardiac source of cerebral emboli

To study the ability of transesophageal echocardiography in detecting cardiac source of emboli in patients with cerebral stroke [Transient Ischemic Attack [TIA] or infarction]. Transthoracic and Biplane Transesophageal echocardiographic studies were performed in 30 consecutive patients with cerebral infarction or TIA. Transesophageal echocardiography identified cardiac source of embolism in 15 patient [50%] of patients where transthoracic echocardiography identified cardiac source of emboli in only 2 patient [6.7%] P<0.0005, the group of patients with no cardiovascular disease clinically were 10 patients with normal transthoracic echocardiography but transesophageal echocardiography revealed mitral valve prolapse in one patient and aortic protruding atheroma in another patient as a source of emboli, in the group of patients with clinical evidence of cardiovascular disease 20 patients transesophageal echocardiography was detecting cardiac source of emboli in the form of left atrial thrombus in 3 patients, left atrial spontaneous echo contrast in 6 patients, prosthetic cardiac valve thrombus or vegetation in 5 patients and patent foramen oval in one patient, All patients thrombi not detected with transthoracic echocardiography. Transesophageal echocardiography is superior than transthoracic echocardiography in detecting the cardiac source of emboli in patients with embolic cerebral stroke or transient Ischemic attacks

study of spontaneous echo contrast in patients with rheumatic mitral stenosis and normal sinus rhythm

To study the incidence of spontaneous echocontrast in left atrium of patients having rheumatic mitral stenosis with normal sinus rhythm and to define its relations. Transthoracic and Biplane transesophageal echocardiographic studies were performed in 50 consecutive patients with rheumatic mitral stenosis who were in normal sinus rhythm. Spontaneous echo contrast in the left atrium was seen in 60% of patients on Biplane transoesophageal echocardiography and in only 4% on transthoracic. Echocardiographic results The mean mitral valve area was 1.07 + 0.33 cm2 and 1.32 +0.45 cm2 [P=0.004], mean left atrial size was 4.27 + 0.67 cm and 3.91 + 0.5 cm. [P=0.029], mean diastolic pressure gradient was 12.64 + 5.69] mm Hg and 10 + 5.5 mm Hg [P=0.049], and absence of mitral regurgitation was seen in 50% and 30% of patients respectively [P=0.1] among patients with spontaneous echo contrast, 30% had either left atrial/or appendage thrombus or history of embolism, versus 0% in patients without spontaneous echo contrast [P<0.0001]. There is a high incidence of spontaneous echo contrast in the left atrium in patient with rheumatic mitral stenosis in normal sinus rhythm on Biplane transesophageal echocardiography. These patients are likely to embolise or form thrombi in the left atrium