Utility of Transesophageal Echocardiography in Determining the Source of Arterial Embolization

Mariano, Myron C.; Gutierrez, Charles J.; Alexander, Jason Q.; Katz, Steven G.; Kohl, Roy D.; Roth, Fernando
September 2002
American Surgeon;Sep2002, Vol. 68 Issue 9, p765
Academic Journal
Arterial embolism is frequently the product of a cardiac source. Arterial-arterial embolization and paradoxical embolization also occur. Failure to identify the point of origin may subject the patient to an important incidence of preventable events. Conventional echocardiography is insensitive in identifying a cardiac origin of emboli and is of little use in identifying sources of arterial-arterial emboli. Aortography is invasive and not as sensitive in detecting mobile aortic thrombus, which is a recently reported embolic source. Herein we describe seven cases in which transesophageal echocardiography was uniquely valuable in identifying the source or mechanism of arterial embolization. We performed chart reviews of patients with arterial emboli definitively diagnosed after utilizing transesophageal echocardiography. Four females and three males with a mean age of 68 years were included in the study. Peripheral embolization occurred in four patients, visceral embolization occurred in one patient, and two patients experienced cerebrovascular events. Six patients had transthoracic echocardiography and six patients had aortography. None of these studies identified the source of embolization. All patients were diagnosed with transesophageal echocardiography. Mobile aortic thrombus was the primary embolic source in three patients, paradoxical embolization occurred in two patients, and two patients had a combination of findings including one patient with atrial thrombus. Two patients received operative repair of the aorta and five underwent nonoperative management. There was one mortality in the operative group. The source of arterial emboli remains obscure in some patients. Transesophageal ultrasound can be valuable in identifying the source or mechanism of embolization even when angiography and conventional echocardiography are negative.


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