| Transesophageal echocardiography in patients with cryptogenic stroke: does it alter their management? A 3-year retrospective study in a single non-referral centre. | |
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MedLine Citation:
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PMID: 17240738 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cardiac embolism is estimated to be the aetiology of ischemic cerebral-vascular insults (CVI) in 25% of cases. Transesophageal echocardiography (TEE) is a reliable and widely used examination in the diagnosticwork-up of stroke. TEE is superior to transthoracic echocardiography (TTE) in the search of minor sources of cardiac embolism but it is time consuming and has its inherent risks. AIM: The aim of this study was to determine whether in patients younger than 65 years of age with CVI our TEE-findings would alter their management. Only patients in whom nor the medical record, nor TTE, nor Carotid Ultrasonography could establish an aetiology, were included. METHODS: A 3-year retrospective study was done in patients admitted to the stroke unit of a regional medical centre covering 110,000 inhabitants. The TEE-database was reviewed and all TEE's performed in eligible patients were selected. Minor and major sources of cardiac embolism were listed. The impact of TEE-findings on the management of CVI was evaluated. RESULTS: Fifty-four patients fulfilled the criteria for this study. The mean age was 52 years (range 18 - 65). A major source of cardiac embolism was seen in 6 cases (11.1%). Four patients (7.4%) had infective endocarditis (IE) with vegetations. A small apical thrombosis in a patient with isolated left ventricular non-compaction was noted and in 1 patient dysfunction of a mechanical prosthetic valve was documented. The most frequently encountered minor source of cardiac embolism was a patent foramen ovale (PFO) or small atrial septal defect (ASD) with documented right-to-left shunt during Valsalva manoeuvre (15 patients, 27.8%). Of these 15 patients, an atrial septum aneurysm(ASA) was seen in 7 patients (13%). Our TEE-findings altered the management of CVI substantially in 21 cases (38.9%). The 4 patients with IE and the patient with mechanical valve dysfunction had cardiac surgery. Twelve patients (22.2%) were referred for percutaneous closure of the PFO/ASD. Three patients with PFO/ASD and the patient with IVNC were treated with maintenance therapy of oral anticoagulation. CONCLUSION: In 1 out of 3 patients, younger than 65 years, suffering from CVI in whom nor medical history, nor TTE, nor Carotid Ultrasound could reveal the cause of the CVI our TEE-findings altered their management. |
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Authors:
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J Walpot; W H Pasteuning; M Hoevenaar; J den Braber; J Sorgedrager; M Oostdijk-de Rijke; L van Kooten-Meyer |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Acta clinica Belgica Volume: 61 ISSN: 0001-5512 ISO Abbreviation: Acta Clin Belg Publication Date: 2006 Sep-Oct |
Date Detail:
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Created Date: 2007-01-23 Completed Date: 2007-02-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370306 Medline TA: Acta Clin Belg Country: Belgium |
Other Details:
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Languages: eng Pagination: 243-8 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Ziekenhuis Walcheren, Vlissingen, The Netherlands. walpot@zwv.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Echocardiography, Transesophageal* Embolism / diagnosis* Female Heart Diseases / diagnosis*, ultrasonography Heart Septal Defects, Atrial / complications, therapy, ultrasonography Humans Male Middle Aged Retrospective Studies Stroke / etiology* Valsalva Maneuver |
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