Usefulness of transoesophageal echocardiography in ischaemic stroke

Abstract

Background: Aorta can be a source of embolic stroke, and study of aorta can sometimes give us insight into the atheromatous process going on in the vascular tree. Another important source for emboli can be the left atrium and its appendage. Transoesophageal echocardiography (TEE) is useful in studying the different parts of aorta, mitral valve apparatus, interatrial septal identification and measuring patent foramen ovale, aneurysmal atrial septum and myxoma of the left atrium. Methods: We retrospectively studied the TEE findings in 500 patients with ischaemic stroke seen at CARE Hospital, Nampally, Hyderabad, Telangana state from their care records. Results: There were 362 males (male: female = 2.6). Different grades of abnormalities were seen in the aorta, more commonly in the arch and descending aorta. The atrial septal abnormalities were seen in 18 cases. Clots or masses within the atria or ventricles were seen in 22 patients. The mitral valve was more often diseased in ischaemic stroke patients, though aortic valve disease or even multiple valve disease was also seen in many patients, and the valve disease was of different grades. Conclusions: TEE was useful in identifying an embolic source in 10% of patients and helped in initiating anticoagulation. It was also useful in identifying complex aortic atheroma in another 92 (18.4%) cases and helped in starting different antiplatelet drug combination or anticoagulation. TEE helped in identifying the pathogenesis of strokes with difficult to identify mechanisms.

Keywords

• atheromatous plaques
• embolic stroke
• stroke
• transoesophageal echocardiography