Value of transesophageal echocardiography and routine peripheral doppler study in the detection of silent embolism

25 patients with known cardiac disease and no signs and symptoms of peripheral embolism were included in this study. Peripheral Doppler study could demonstrated obstruction in the peripheral arterial tree of the lower limb in 8 of them. Transthoracic echocardiography fail to demonstrate the source of emboli in any of these cases while transesophageal study could detect source of emboli in 6 of the 25 cases included in the study. Only 2 of these cases had such positive finding in transthoracic study and 3 of these cases had silent arterial obstruction on peripheral Doppler study. It was concluded that routine periodic Doppler study of the peripheral arterial tree of the lower limbs is needed to detect cases with silent emboli. These cases should be selected and subjected to transesophageal echocardiography to determine the source of the embolism and its nature aiming at early diagnosis and prevention of major acute leg ischemia or stroke