부산대학교 도서관

Objective : Transesophageal echocardiography (TEE) has recently emerged as a very promising tool for identifying cardiovascular sources of embolism. This study was designed to evaluate the utility of TEE for detecting the cardiovascular embolic risks in patients with cerebral infarction. Materials & Methods : TEE was performed in 144 consecutive patients with cerebral infarction who were admitted to our hospital between June 1997 and December 2000. Patients were divided into three groups by cardiac rhythm, and there were 71 patients with chronic atrial fibrillation, 18 patients with paroxysmal atrial fibrillation, and 55 patients with sinus rhythm. The potential cardiovascular sources of embolism were defined into 4 categories : (1) left-sided intracardiac mass (thrombi, vegetation, and tumor); (2) dense left atrial spontaneous echo contrast ; (3) reduced left atrial appendage blood flow velocity (<20cm/sec); and (4) complex aortic plaque. Results : Among 144 patients, at least one potential cardiovascular embolic risks was detected in 104 patients (72.2%) : 57 patients (39.6%) with intracardiac mass, 53 patients (36.8%) with dense left atrial spontaneous echo contrast, 52 patients (36.1%) with complex aortic plaque and 33 patients (22.9%) with reduced left atrial appendage blood flow velocity. The prevalence and number of cardiovascular embolic risks increased with age. Cardiovascular embolic risks were also more prevalent in the chronic and paroxysmal atrial fibrillation groups than in the sinus rhythm group (p<0.001 and p<0.05, respectively). However, the patients in the Chronic atrial fibrillation group had significantly more multi embolic risks than the paroxysmal atrial fibrillation groups (p<0.001). Conclusions : Using TEE, potential sources of embolism were detected in about 70% of patients with cerebral infarction. TEE may be a helpful diagnostic tool for the identification of possible cardiovascular embolic sources.