Arquivos Brasileiros de Cardiologia
Resumo das Próximas Publicações
Clinical Impact of Transesophageal Echocardiography in Patients with Stroke without Clinical Evidence of Cardiovascular Sources of Emboli
Solange Bernardes Tatani, Márcia Maiumi Fukujima, João Augusto Costa Lima, Luiz Darcy Cortez Ferreira, Claudia G. Monaco Ghefter, Gilmar Fernandes Prado, Zara Babayan, Lyamara Apostólico de Azevedo
Objective – The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli.
Methods – We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. We determined that transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid.
Results - Transeophageal echocardiography detected at least one abnormality in 40 cases (58%): 15 patients had patent foramen ovale, 7 patients had interatrial septal aneurysms, 1 patient had interatrial communication, 3 patients had intracavitary thrombi, 19 patients had spontaneous echo contrast, and 10 patients had aortic atherosclerotic plaques >4-mm thick. Furthermore, a diagnosis of aortic dissection was made in one patient. Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9%); anticoagulation was added in 10 cases and surgical correction in one patient.
Conclusion - Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism.
Key words: transeophageal echocardiography, stroke, and embolism.
OMNI – Centro de Cardiologia Não Invasiva (Division of
Noninvasise Cardiology), UNIFESP-Escola Paulista de Medicina, John Hopkins
University – USA