[CLASSIFICATION AND PHONOCARDIOGRAPHIC PATTERNS IN ACQUIRED VALVULOPATHIES].
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The clinical and echocardiographic variables related to spontaneous echo contrast were evaluated in a consecutive series of 600 patients undergoing transesophageal echocardiography with a 5-MHz single plane transducer. The spontaneous contrast was observed in 110 patients (18%). It was seen mainly in the atria; in the left atrium in 98, in the right atrium in 2 patients, in both atria 7, in the vena cava superior and right atrium in 1, in the left atrium and ventricle in 1, and in the false lumen of dissected aorta. Spontaneous atrial contrast was never seen in the absence of cardiac abnormality. There was a high incidence of atrial spontaneous echo contrast in cases of significant mitral stenosis, mitral valve prosthesis, atrial fibrillation, enlarged left atrium and absence of significant mitral regurgitation which were showed by univariate analysis. Multivariate analysis showed that atrial fibrillation, significant mitral stenosis and enlarged left atrium were independent factors for the presence of spontaneous contrast. Thus, spontaneous echocardiographic contrast detected by transesophageal echocardiography is a common finding in patients with mitral stenosis, atrial fibrillation and enlarged left atrium, in the absence of significant mitral regurgitation.
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This article examines the transesophageal echocardiographic assessment of the left atrial appendage anatomy and function in individuals without significant structural heart disease and in those with atrial fibrillation with or without cardioembolism or mitral valve stenosis. We also summarize the available data in the usefulness of transesophageal echocardiographic studies in patients undergoing cardioversion for atrial fibrillation and percutaneous balloon valvuloplasty for mitral stenosis. Also, potential limitations and ongoing developments in the use of transesophageal echocardiography in the assessment of the left atrial appendage are outlined, and recommendations are given for the uniform reporting of quantitative data.