Does transesophageal echocardiography accurately identify or exclude left atrial thrombi compared to direct visualization during cardiac surgery in patients undergoing elective mitral valve surgery or left atrial tumor excision?
Transesophageal echocardiography is highly accurate for identifying or excluding left atrial thrombi, with 100% sensitivity and 99% specificity compared to direct surgical visualization.
OBJECTIVE: To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: 231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism. MEASUREMENT: Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery. RESULTS: Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size range from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% 95% CI, 74% to 100%; specificity, 99% CI, 97% to 99.9%; positive predictive value, 86% 12/14; negative predictive value, 100% 217/217; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery. CONCLUSION: Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.
Warren J. Manning (1995) studied this question.