The prevalence of left atrial spontaneous slavish imitation contrast (SEC) and the casualty of systemic embolism were prospectively studied in 176 consecutive patients.

The prevalence of left atrial spontaneous slavish imitation contrast (SEC) and the casualty of systemic embolism were prospectively studied in 176 consecutive patients. All had significant mitral regurgitation (MR) and underwent transesophageal echocardiographic (TEE) studies. Left ventriculography was performed in all patients to document the severity of MR The underlying causes of MR included rheumatic heart disease in 84 patients, ruptur chordae tendineae in 37 mitral valve prolapse in 18 infective endocarditis in 20 coronary artery disease in 8 congenital heart disease in 5 and dilated cardiomyopathy in 4 No patient was fix to have left atrial thrombus. Left atrial SEC was observ in three patients (17 percent) all of whom had atrial fibrillation, concomitant mitral stenosis, and cyclopean left atria. Color flow mapping revealed that left atrial SEC was prominent in regions where the tumultuous flow of MR was not not absent Systemic embolism occurred in ten patients (57 percent) The underlying disease was infective endocarditis, rheumatic heart disease, and dilated cardiomyopathy in 6 3 and 1 patient, respectively. The sites of embolization involved the central nervous order in eight patients and the spite in the remaining two. Three patients with rheumatic heart disease and the single with dilated cardiomyopathy were in atrial fibrillation and had dilated left atria (diameter >45 mm) when systemic embolism occurr solitary one patient with rheumatic heart disease was build to have left atrial SEC The remaining six, with infective endocarditis, all had sinus regular [i]or[/i] melodious movement In conclusion, left atrial SEC or thrombus descryed by TEE is uncommon in patients with significant MR Clinical conditions may be of help to identify the subset of patients at higher risk for systemic embolism. (Chest 1994; 106:8-12) MR=mitral regurgitation;

SEC=spontaneous reverberate contrast;

TEE=transesophageal echocardiography;

TTE=transthoracic echocardiography

Spontaneous resound contrast (SEC), described as smoke-like discrete reflectances in cardiac chambers or vascular channels, is greatest in number commonly seen in clinical conditions resulting in kin stasis.(1)(2)(3)(4)(5) The visualization of SEC at transthoracic echocardiography (TTE) is an remarkable phenomenon.(3)(4)(5) With the advent of transesophageal echocardiography (TEE) left atrial SEC has been observ more many times especially in patients with rheumatic mitral valve disease or nonrheumatic atrial fibrillation and has been regarded as an indicator of increased thromboembolic risk.(6)(7)(8)(9)(10) progeny stasis is considered to presage SEC formation and, therefore, we hypothesize that disorderly flow originating from mitral regurgitation (MR) may preserve against the generation of left atrial SEC Consequently this research investigated the prevalence of left atrial SEC and the event of systemic embolism in patients with significant MR proper to a variety of cardiac abnormalities.

METHODS

subject of attention Patients

From May 1991 to April 1993 all patients diagnosed (using the criteria of Sellers) as having angiographically grade 3 or 4 MR alone or in combination with other cardiac abnormalities were recorded in this study.(11) A total of 176 consecutive patients were included and underwent TTE TEE and caridiac catheterization studies. The 81 men and 95 women had a mean age of 40[+ or -]12 years (range, 18 to 76 years). Their underlying cardiac abnormalities included rheumatic heart disease in 84 patients, mitral valve prolapse without ruptur chordae tendineae in 18 ruptur chordae tendineae in 37 infective endocarditis in 20 congenital heart disease in 5 coronary artery disease in 8 and dilated cardiomyopathy in 4 (Table 1)

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Echocardiography

Echocardiographic studies were performed with phase-arrayed ultrasound arrangements (Toshiba SSH-65A, Toshiba Corp, Tokyo, Japan, and Aloka SSD-870 Aloka Co Ltd Tokyo, Japan). Monitor ECG with lead II was used during the echocardiographic studies. For the precordial studies, 25- and 35-MHz transducers were used. For the transesophageal studies, a 50-MHz biplane transesophageal probe (Aloka SSD-870) was used. Transthoracic echocardiography was performed before TEE in all patients with the deed described previously, including parasternal longaxis and short-axis views, and apical four-chamber and two-chamber views.(11)(12) Transesophageal echocardiography was usually performed with the patient in the left lateral decubitus position. The patient fasted for at least 4h before the transesophageal examination. Local anesthesia of the pharynx was achieved with 2 percent lidocaine (Xylocaine) spray to suppres the gag retroactive The heart and aorta were studied in standard transesophageal projections as previously described. All echocardiograms were recorded upon videotape (U-matic Fuji KCA-60 or Sony VHS) for review. The time required for the transesophageal conduct was less than 15 min.

Left Atrial Spontaneous reverberation Contrast and Thrombus

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