Impacto clínico da ecocardiografia transesofágica em pacientes com acidente vascular cerebral sem evidência clínica de fonte emboligênica cardíaca / Clinical impact of transesophageal echocardiography in patients with stroke without clinical evidence of cardiovascular sources of emboli

OBJECTIVE: The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli. METHODS: We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. Transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid. RESULTS: Transeophageal echocardiography detected at least one abnormality in 40 cases (58 percent). Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9 percent); anticoagulation was added in 10 cases and surgical correction in one patient. CONCLUSION: Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism

Mudanças posturais durante realização do ecocardiograma. Manobra obrigatória no diagnóstico diferencial entre trombos fixos e flutuantes? / Postural changes during two-dimensional echocardiography. Is this manoeuver necessary in the differential diagnosis between fixed ond free floating thrombus

A case of a 62 year-old woman with mitral stenosis and thrombosis of the left atrium diagnosed by two-dimensional echocardiography (2D-Echo) is reported. During the procedure, postural changes were performed and characterized the thrombus as floating one. The postural changes during 2D-echo examination allows differential diagnosis among fixed and free floating atrial thrombus. Such postural manoeuvres are also important in evaluating prognosis and therapeutic management of mitral stenosis.

Mulher de 62 anos, com trombose no átrio esquerdo detectada ao ecocardiograma, onde mudanças de decúbito da paciente durante a realização do exame permitiram a caracterização da flutuabilidade do trombo. A mudança postural durante o ecocardiograma para a diferenciação entre trombos atriais fixos e móveis, tem importância na avaliação prognóstica e planejamento terapêutico da estenose mitral

Ecocardiografia transesofágica biplanar: experiência em 130 pacientes ambulatoriais / Biplane transesophegeal echocardiography: An experience with 130 outpatients

Objetivo: Analisar a utilidade da ecocardiografia transesofágica (ETE) como método complementar ao ecocardiograma transtorácico, comparando resultados e avaliando acréscimo de informaçöes. Métodos: Foram inclusos os primeiros 130 exames transesofágicos realizados, consecutivamente, em pacientes ambulatoriais. Sessenta e seis pacientes eram do sexo masculino e as idades variaram entre 12 a 84 anos. A indicaçäo principal do exame apresentou a seguinte distribuiçäo: avaliaçäo de próteses valvares = 21 pacientes; pesquisa de trombos endocavitários = 43; suspeita de aortopatias = 17; endocardite infecciosa = 14; cardiopatias congênitas = 14; outras afecçöes = 21. Resultados: A ETE forneceu informaçöes adicionais ao estudo transtorácico na avaliaçäo anatômica e funcional do coraçäo, onde se destacam: detecçäo de refluxo paravalvar observado em 38// dos pacientes com prótese valvar; vegetaçöes endocárdicas visibilizadas em 45.5// dos pacientes com suspeita clínica de endocardite infecciosa, näo detectadas pela técnica transtorácica. Dissecçäo da aorta foi diagnosticada em 35,2// dos casos com suspeita de aortopatia e comunicaçäo interatrial foi detectada em 80// dos pacientes encaminahdos para investigaçäo do septo interatrial. Conclusäo: A ETE é método diagnóstico näo invasivo moderno e seguro que deve ser utilizado como técnica complementar na abordagem do átrio e apêndice atrial esquerdos, aorta torácica, e na avaliaçäo de próteses valvares e endocardite infecciosa

Purpose: To analyse the utility of transesophageal echocardiography (TEE) as a complementary technique to transthoracic echocardiographyc (TTE) comparing results and additional informations. Methods: One hundred and thirty consecutive outpatients (66 mule) submitted to TEE, with age ranging from 12 to 84 years were studied. Patients were grouped according to the main indication: evaluation of prosthetic valves, 21 patients; cardiac source of emboli, 43; diseases of the aorta, 17; infective endocarditis, 14; congenital heart diseases, 14 and other abnornalities in 21 patients. Results: TEE provided additional and important information in all groups. Perivalvalar leakage was observed in 42.1% of patients with prosthetic valves. Vegetations were detected in 45.5% of the suspected cases of endocarditis (missed by TTE). Dissection of aorta was diagnosed in 35,2% of patients with suspected disease and atrial septal defect was successfully recognized in 80% of the cases. No complications were observed. Conclusion: TEE is a sofe and usefull complementary non-invasive diagnostic tool in the assessment of structures such as leit atriam, left atrial appendage, thoracic aorta, prosthetic valves and in the investigation of infective endocarditis