Transesophageal Echocardiographic Findings of Ischemic Stroke without Obvious Cardiac Disease

Kyoung-Sig Chang; Gi-Wan An; Won-Young Jeong

doi:10.3803/jkes.1994.2.1.80

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Chang, An, and Jeong: Transesophageal Echocardiographic Findings of Ischemic Stroke without Obvious Cardiac Disease

Original Article

J Korean Soc Echocardiogr 1994;2(1):80-87.

Published online: 18 February 1994

DOI: https://doi.org/10.3803/jkes.1994.2.1.80

Transesophageal Echocardiographic Findings of Ischemic Stroke without Obvious Cardiac Disease

Kyoung-Sig Chang, M.D., Gi-Wan An, M.D., Won-Young Jeong, M.D.^∗

Department of Internal Medicine, Chosun University Hospital, Kwangju, Korea

^∗Department of Neurology, Chosun University Hospital, Kwangju, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To detect the cardiac source of embolism in patient of ischemic stroke of uncertain etiology, biplane transesophageal echocardiography and contrast echocardiography with hand-agitated saline were performed 27 patients(sixteen men and eleven women) of transient ischemic attack and cerebral infarction without definitive cardiac symptom and sign.

Transesophageal echocardiography showed potential sources of embolism in nineteen patients (70.4%) including atrial septal aneurysm(n = 9. three of them had patent foramen ovale), spontaneous contrast echo(n = 3), mitral valve prolapse(n = 1), unknown thickening of the tip of the mitral valve(n = 1) and atherosclerotic plaque in descending aorta(n = 7).

Thus transesophageal echocardiography and contrast echocardiography identify potential cardiac source of embolism, and provide the rationale of the thrombolytic and anticoagulant therapy in patients with ischemic stroke without obvious cardiac disease.

Keywords: TEE (transesophageal echocardiography), Contrast echocardiography, Ischemic stroke.

References

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Fig. 1.

A; Transesophageal echocardiogram showing an atrial septal aneurysm(Arrow). The atrial septum bulges towards the left atrium. B; After hand-agitated contrast administration contrast fills right atrium (RA), right ventricular outflow tract(RVOT) and atrial septal aneurysm(open arrow). C; The small amount of contrast enters into left atrium(three open arrows), suggesting existing the patent foramen ovale.

Fig. 2.

A; M-mode echocardiogram of the right atrium(RA) and interatrial septum showing the smoke-like spontaneous contrast echo in right atrium(RA). B; Longitudinal plane of transesophageal echocardiogram showing spontaneous contrast echo in the left ventricular inflow tract. LA; left atrium, LV; left ventricle.

Fig. 3.

M-mode echocardiogram of descending aorta(DA) showing spontaneous contrast echo. Note the changes of spontaneous contrast echo during systole(arrows).

Fig. 4.

Transesophageal four-chamber view showing the redundant anterior leaflet protruding into left atrium(LA) during systole(open arrow).

Fig. 5.

Transesophageal echocardiogram of mitral valve showing small round thickening of the tip of the both leaflets(arrow). A; diastole, B; systole.

Fig. 6.

Transverse plane of transesophageal echocardiogram(A and B) of ascending aorta(ASC. AO) showing the protruding atheroma. Filamentous portion(right side) of atheromatous plaque is moving freely. Longitudinal plane of transesophageal echocardiogram of the same level shows curvilinear atheromatous plaque.

Fig. 7.

Transverse plane(A) and longitudinal plane(B) of transesophageal echocardiogram showing a large protruding atherosclerotic plaque in descending aorta.

Table 1.

Transesophageal echocardiographic findings for potential sources of cerebral emboli

TEE finding	Number (%)
Atrial septal aneurvsm	9 (33.3)
without patent foramen ovale	6 (22.2)
with patent foramen ovale	3 (11.1)
Spontaneous contrast echo	3 (11.1)
Mitral valve prolapse	1 (3.7)
Unknown thickening of tip of both leaflet of mitral valve	1 (3.7)
Atherosclerotic plaque of descending aorta	7 (25.9)
Unknown for potential sources of cerebral emboli	8 (29.6)

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