Transesophageal echocardiography and cardiovascular sources of embolism: Implications for perioperative management

Anesthesiology

Volumn 107, Issue 2, 2007, Pages 333-346

  Tan, Christine Ngukhoon ^a   Fraser, Alan G ^b  

^a UNIVERSITY HOSPITAL OF WALES   (United Kingdom)

^b CARDIFF UNIVERSITY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

AIR EMBOLISM; ANESTHESIA; AORTA ATHEROSCLEROSIS; CARDIOVASCULAR RISK; CARDIOVASCULAR SYSTEM; CLINICAL DECISION MAKING; DIFFERENTIAL DIAGNOSIS; EMBOLISM; FIBROELASTOMA; HEART ATRIUM FUNCTION; HEART ATRIUM SEPTUM DEFECT; HEART ATRIUM THROMBOSIS; HEART DISEASE; HEART FUNCTION; HEART INJURY; HEART MYXOMA; HEART TUMOR; HEART VENTRICLE THROMBOSIS; HUMAN; INTENSIVE CARE; INTRACARDIAC THROMBOSIS; MITRAL VALVE DISEASE; PRIORITY JOURNAL; REVIEW; SENSITIVITY AND SPECIFICITY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; VASCULAR DISEASE;

ECHOCARDIOGRAPHY, TRANSESOPHAGEAL; EMBOLISM; HEART ATRIA; HEART DISEASES; HUMANS; PERIOPERATIVE CARE; RISK FACTORS;

EID: 34547575459     PISSN: 00033022     EISSN: 15281175     Source Type: Journal    
DOI: 10.1097/01.anes.0000270733.26234.56     Document Type: Review

References (204)

1. Arrowsmith JE, Grocott HP, Reves JG, Newman MF: Central nervous system complications of cardiac surgery. Br J Anaesth 2000; 84:378-93
2. Murdock DK, Rengel LR, Schlund A, Olson KJ, Kaliebe JW, Johnkoski JA, Riveron FA: Stroke and atrial fibrillation following cardiac surgery. Wisc Med J 2003; 102:26-30
3. Di Tullio M, Homma S: Mechanisms of cardioembolic stroke. Curr Cardiol Rep 2002; 4:141-8
4. Lerakis S, Nichoholson W: Part I: Use of echocardiography in the evaluation of patients with suspected cardioembolic stroke. Am J Med Sci 2005; 329:310-16
5. Vitebskiy S, Fox K, Hoit BD: Routine transesophageal echocardiography for the evaluation of cerebral emboli in elderly patients. Echocardiography 2005; 22:770-4
6. Conture P, Denault AY, McKenty S, Boudreault D, Plante F, Perron Babin D, Normandin L, Poirier N: Impact of routine use of intraoperative TEE during cardiac surgery. Can J Anaesth 2000; 47:20-6
7. De Bruijn SF, Agema WR, Lammers GJ, van der Wall EE, Wolterbeek R, Holman ER, Bollen EL, Bax JJ: Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke 2006; 37:2531-4
8. Lengyel M, Horstkotte D, Voller H, Mistiaen WP, Working Group Infection, Thrombosis, Embolism and Bleeding of the Society for Heart Valve Disease: Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis 2005; 14:567-75
9. Bach DS: Transesophageal echocardiography evaluation of prosthetic valves. Cardiol Clin 2000; 18:751-71
10. Jacob S, Tong AT: Role of echocardiography in the diagnosis and management of infective endocarditis. Curr Opin Cardiol 2002; 17:478-85
11. Peters PJ, Reinhardt S: The echocardiographic evaluation of intracardiac masses: A review. J Am Soc Echocardiogr 2006; 19:230-40
12. Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Weiss RL, Mark JB, Savage RM, Sears-Rogan P, Mathew JP, Quinones MA, Cahalan MK, Savino JS: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. J Am Soc Echocardiogr 1999; 12:884-900
13. Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y: Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: Systematic review and meta-analysis. Arch Intern Med 2006; 166:1350-6
14. Min JK, Spencer KT, Furlong KT, DeCara JM, Sugeng L, Ward RP, Lang RM: Clinical features of complications from transesophageal echocardiography: A single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr 2005; 18:925-9
15. Kallmeyer IJ, Collard CD, Fox JA, Body SC, Shernan SK: The safety of intraoperative transesophageal echocardiography: A case series of 7200 cardiac surgical patients. Anesth Analg 2001; 92:1126-30
16. Yamaji K, Fujimoto S, Yutani C, Hashimoto T, Nakamura S: Is the site of thrombus formation in the LAA associated with the risk of cerebral embolism? Cardiology 2002; 97:104-10
17. Von der Recke G, Schmidt H, Illien S, Luderitz B, Omran H: Use of transesophageal contrast echocardiography for excluding LAA thrombi in patients with atrial fibrillation before cardioversion. J Am Soc Echocardiogr 2002; 15:1256-61
18. Ha JW, Lee BK, Kim HJ, Pyun WB, Byun KH, Rim SJ, Chung N: Assessment of left atrial appendage filling pattern by using intravenous administration of microbubbles: Comparison between mitral stenosis and mitral regurgitation. J Am Soc Echocardiogr 2001; 14:1100-6
19. Kaymaz C, Ozdemir N, Kirma C, Sismanoglu M, Daglar B, Ozkan M: Location, size, and morphological characteristics of LA thrombi as assessed by echocardiography in patients with rheumatic mitral valve disease. Eur J Echocardiogr 2001; 2:270-6
20. Stoddard MF, Singh P, Dawn B, Longaker RA: Left atrial thrombus predicts transient ischemic attack in patients with atrial fibrillation. Am Heart J 2003; 145:676-82
21. Abe Y, Asakura T, Gotou J, Iwai M, Wantanabe Y, Sando M, Ishikawa S, Nagata K, Saito T, Maehara K, Maruyama Y: Prediction of embolism in atrial fibrillation: Classification of left atrial thrombi by transesophageal echocardiography. Jpn Circ J 2000; 64:411-5
22. Vincelj J, Sookol I, Jaksic O: Prevalence and significance of left atrial SEC detected by transesophageal echocardiography. Echocardiography 2002; 19:319-24
23. Maltagliati A, Pepi M, Tamborini G, Muratori M, Celeste F, Doria E, Galli C: Usefulness of multiplane TEE in the recognition of artifacts and normal variants that may mimic LA thrombi in patients with atrial fibrillation. Ital Heart J 2003; 4:797-802
24. Stollberger C, Chnupa P, Kronik G, Brainin M, Finsterer J, Schneider B, Slany J: Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. ELAT Study Group. Embolism in Left Atrial Thrombi. Ann Intern Med 1998; 128:630-8
25. Srimannarayana J, Varma RS, Satheesh S, Anilkumar R, Balachander J: Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: A transesophageal echocardiographic study. Indian Heart J 2003; 55:358-61
26. Gonzalez-Torrecilla E, Garcia-Fernandez MA, Perez-David E, Bermejo J, Moreno J, Delcan JL: Predictors of LA spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation. Am J Cardiol 2000; 86:529-34
27. Lopez-Candales A, Edelman K: Large left atrial appendage thrombus in the presence of severe mitral regurgitation: Contradictory hemodynamics or expected findings. Echocardiography 2004; 2:625-9
28. Laplace G, Lafitte S, Labeque JN, Perron JM, Baudet E, Deville C, Roques X, Roudaut R: Clinical significance of early thrombosis after prosthetic mitral valve replacement: A postoperative monocentric study of 680 patients. J Am Coll Cardiol 2004; 43:1283-90
29. Panagiotopoulos K, Toumanidis S, Vemmos K, Saridakis N, Stamatelopoulous S: Secondary prognosis after cardioembolic stroke of atrial origin: The role of left atrial and left atrial appendage dysfunction. Clin Cardiol 2003; 26:269-74
30. Sadanandans S, Sherrid MV: Clinical and echocardiographic characteristics of left atrial spontaneous echo contrast in sinus rhythm. J Am Coll Cardiol 2000; 35:1932-38
31. Ito T, Suwa M, Kobashi A, Yagi H, Nakamura T, Miyazaki S, Kitaura Y: Integrated backscatter assessment of left atrial SEC in chronic nonvalvular AF: Relation with clinical and echocardiographic parameters. J Am Soc Echocardiogr 2000; 13:666-73
32. Bashir M, Asher CR, Schaffer K, Murray RD, Apperson-Hansen C, Jasper S, Thomas JD: Left atrial appendage SEC in patients with arrhythmia using integrated backscatter and transesophageal echocardiography. Am J Cardiol 2001; 88:923-5
33. Bernhardt P, Schmidt H, Hammersting C, Luderitz B, Omran H: Patients with AF and dense SEC at high risk: A prospective and serial follow-up over 12 months with TEE and cerebral MRI. J Am Coll Cardiol 2005; 45:1807-12
34. Handke M, Harloff A, Hetzel A, Olschewski M, Bode C, Geibel A: Left atrial appendage flow velocity as a quantitative surrogate parameter for thromboembolic risk: Determinants and relationship to spontaneous echocontrast and thrombus formation- a transesophageal echocardiographic study in 500 patients with cerebral ischemia. J Am Soc Echocardiogr 2005; 18:1366-72
35. Bashir M, Asher CR, Garcia MJ, Abdalla I, Jasper SE, Murray RD, Grimm RA, Thomas JD, Klein AL: Atrial spontaneous echo contrast and thrombi in atrial fibrillation: A transesophageal echocardiography study. J Am Soc Echocardiogr 2001; 14:122-7
36. Thumala A, Parra C, Maragano P, Puelma A, Florenzano F: Thromboembolic risk factors in atrial flutter: A transesophageal echocardiographic study. Rev Med Chil 2000; 128:1327-34
37. Shaw TR, Northridge DB, Francis CM: Left atrial standstill in a patient with mitral stenosis and sinus rhythm: A risk of thrombus hidden by left and right atrial electrical dissociation. Heart 2003; 89:1173
38. Corrado G, Beretta S, Sormani L, Tadeo G, Foglia-Manzillo G, Tagliagambe LM, Santarone M: Prevalence of atrial thrombi in patients with atrial fibrillation and subtherapeutic anticoagulant prior to cardioversion. Eur J Echocardiogr 2004; 5:257-61
39. Wang YC, Lin JL, Hwang JJ, Lin MS, Tseng CD, Huang SK, Lai LP, Wang YS: Left atrial dysfunction in patients with atrial fibrillation after successful rhythm control for more than 3 months. Chest 2005; 128:2551-6
40. Ren JF, Marchlinski FE, Callans DJ: Left atrial thrombus associated with ablation for atrial fibrillation: Identification with intracardiac echocardiography. J Am Coll Cardiol 2004; 43:1861-7
41. Khan IA: Atrial stunning: Basic and clinical considerations. Int J Cardiol 2003; 92:113-28
42. Klein AL, Grimm RA, Jasper SE, Murray RD, Apperson-Hansen C, Lieber EA, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF: ACUTE Steering and Publication committee for the ACUTE investigators: Efficacy of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation at 6 months: A randomized controlled trial. Am Heart J 2006; 151:380-9
43. Thambidorai SK, Murray RD, Parakh K, Shah TK, Black IW, Jasper SE, Li J, Appleson-Hansen C, Asher CR, Grimm RA, Klein AL: Utility of transesophageal echocardiography in identification of thrombogenic milieu in patients with atrial fibrillation (an ACUTE ancillary study). Am J Cardiol 2005; 96:935-41
44. Jaber WA, Prior DL, Thamilarsasan M, Grimma RA, Thomas JD, Klein AL, Asher CR: Efficacy of anticoagulation in resolving left atrium and left atrial appendage thrombi: A transesophageal echocardiographic study. Am Heart J 2000; 140:150-6
45. Tansuphaswadikul S, Hengrussamee K, Chantadansuwan T, Silaruks S, Kehasukcharoen W, Saejueng B: Transesophageal echocardiography during percutaneous mitral commissurotomy in patients with left atrial thrombus. J Med Assoc Thai 2001; 84:1534-40
46. Ostermayer SH, Reisman M, Kramer PH, Mathew RV, Gray WA, Block PC, Omran H, Bartorelli AL, Della BP, Di Mario C, Pappone C, Casale PN, Moses JW, Poppas A, Williams DO, Meier B, Skanes A, Teirstein PS, Lesh MD, Nakai T, Bayard Y, Billinger K, Trepels T, Krumsdorf U, Sievert H: Percutaneous left atrial appendage transcatheter occlusion (PLAATO) system to prevent stroke in high risk patients with non-rheumatic atrial fibrillation: Results from the international multicenter feasibility trials. J Am Coll Cardiol 2005; 46:9-14
47. Ha JW, Chung N, Hong YW, Kwak YR, Chang BC, Cho SY: Alteration of surgical management following intraoperative transesophageal echocardiography in a patient with mobile left atrial thrombi embolized during anesthesia. Echocardiography 2003; 20:291-2
48. Garcia-Fernandez MA, Perez-David E, Quiles J, Peralta J, Garcia-Rojas I, Bermejo J, Moreno M, Silva J: Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis: A transesophageal echocardiographic study. J Am Coll Cardiol 2003; 42:1253-8
49. Schneider B, Stollberger C, Sievers HH: Surgical closure of the left atrial appendage: A beneficial procedure? Cardiology 2005; 104:127-32
50. Barkhausen J, Hunold P, Eggebrecht H, Schuler WO, Sabin GV, Erbel R, Debatin JF: Detection and characterization of intracardiac thrombi on MRI. Am J Roentgenol 2002; 179:1539-44
51. Moreno R, Zamorano JL, Almeria C, Rodrigo JL, Villate A, Serra V, Alvarez L, Aubele A, Sanchez-Harguindey L: Usefulness of contrast agents in the diagnosis of LV aneurysm after acute myocardial infarction. Eur J Echocardiogr 2003; 3:111-6
52. Bednarz JE, Spencer KT, Weinert L, Sugeng L, Mor-Avi V, Lang RM: Identification of cardiac masses and abnormal blood flow patterns with harmonic power Doppler contrast echocardiography. J Am Soc Echocardiogr 1999; 12:871-5
53. Heatlie GJ, Mohiaddin R: Left ventricular aneurysm: Comprehensive assessment of morphology and thrombus using cardiovascular MRI. Clin Radiol 2005; 60:687-92
54. Butany J, Dias B, Grapa J, Mickleborough L, Siu S: Left ventricular pseudoaneurysm. Can J Cardiol 2002; 18:1122-3
55. Moreno R, Gordillo E, Zamorano J, Almeria C, Garcia-Rubira JC, Fernandez-Ortiz A, Macaya C: Long term outcome of patients with post-infarction LV pseudoaneurysm. Heart 2003; 89:1144-6
56. Makaryus AN, Manetta F, Goldner B, Stephen B, Rosen SE, Park CH: Large left ventricular pseudoaneurysm presenting 25 years after penetrating chest trauma. J Interv Cardiol 2005; 18:193-200
57. Stollberger C, Finsterer J: Left ventricular hypertrabeculation/non- compaction. J Am Soc Echocardiogr 2004; 17:91-100
58. Aragona P, Badano LP, Pacileo G, Pino GP, Sinagra G, Zachara E: Isolated left ventricular non-compaction. Ital Heart J 2005; 6:649-59
59. Lowery MH, Martel JA, Zambrano JP, Ferreira A, Eco L, Gallagher A: Non-compaction of the ventricular myocardium: The use of contrast-enhanced echocardiography in diagnosis. J Am Soc Echocardiogr 2003; 16:94-6
60. Koo BK, Choi D, Ha JW, Kang SM, Chung N, Cho SY: Isolated noncompaction of the ventricular myocardium: Contrast echocardiographic findings and review of the literature. Echocardiography 2002; 19:153-6
61. Oechslin EN, Attenhofer Jost CH, Rojas JR, Kaufmann PA, Jenni R: Long-term follow-up of 34 adults with isolated left ventricular non-compaction: A distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 19:153-6
62. Blessing E, Rottbauer W, Mereles D, Hosch W, Benz A, Friess H, Autschbach F, Muller M, Stremmel W, Katu H: Isolated Left ventricular noncompaction of the myocardium as a cause of embolic SMA occlusion. J Am Soc Echocardiogr 2005; 6:693
63. Ileri M, Tandogan I, Kosar F, Yetkin E, Buyukasik Y, Kutuk E: Influence of thrombolytic therapy on the incidence of LV thrombi after acute anterior myocardial infarction: Role of successful reperfusion. Clin Cardiol 1999; 22:477-80
64. Neskovic AN, Marinkovic J, Bojic M, Popovic AD: Predictors of Left ventricular thrombus formation and disappearance after anterior wall myocardial infarction. Eur Heart J 1998; 19:908-16
65. Miyake Y, Sugioka K, Bussey CD, Di Tullio M, Homma S: Left ventricular mobile thrombus associated with ventricular assist device: Diagnosis by transesophageal echocardiography. Circ J 2004; 68:383-4
66. Yilmaz R, Celik S, Baykan M, Kasap H, Kaplan S, Kucukosmanoglu M, Erdol C: Assessment of mitral annular velocities by Doppler tissue imaging in predicting LV thrombus formation after first acute anterior myocardial infarction. J Am Soc Echocardiogr 2005; 18:632-37
67. Sharma S, Ehsan A, Couper GS, Shernan SK, Wholey RM, Aranki SF: Unrecognised LV thrombus during reoperative CABG. Ann Thorac Surg 2004; 78:79-80
68. Scalia GM, McCarthy PM, Savage RM, Smedira NG, Thomas JD: Clinical utility of echocardiography in the management of implantable ventricular assist devices. J Am Soc Echocardiogr 2000; 13:754-63
69. Banchs JE, Dawn B, Abdel-Latif A, Qureshi A, Agrawal N, Bouvette M, Stoddard MF: Acquired aortic cusp fusion after chronic left ventricular assist device support. J Am Soc Echocardiogr 2006; 19:1401.e1-3
70. Ogren M, Bregqvist D, Eriksson H, Lindblad B, Sternby NH: Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: A population-based study of 23 769 consecutive autopsies. Eur Heart J 2005; 26:1108-14
71. Shapiro MA, Johnson M, Feintein SB: A retrospective experience of right atrium and superior vena cava thrombi diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr 2002; 15:76-9
72. Khairy P, Landzberg MJ, Gatzoulis MA, Mercier LA, Fernandes SM, Cote JM, Lavoie JP, Fournier A, Guerra PG, Frogoudaki A, Walsh EP, Dore A, Epicardial versus Endocardial Pacing and Thromboembolic Events Investigators: Transvenous pacing leads and systemic thromboemboli in patients with intracardiac shunts: A multicenter study. Circulation 2006; 113:2391-7
73. Kang CH, Ahn H, Kim KH, Kim KB: Long-term result of 1144 CarboMedics mechanical valve implantations. Ann Thorac Surg 2005; 79:1939-44
74. Shapira Y, Nill M, Hirsch R, Vaturi M, Vidne B, Sagie A: Mid-term clinical and echocardiographic follow-up of patients with CarboMedic valves in the tricuspid position. J Heart Valve Dis 2000; 9:396-402
75. Wenke K, Goppl J, Kronski D, Nowak L, Kemkes B: Endocarditis resulting from thrombotic vegetations on a right ventricular pacing lead. Herz 2005; 30:668-74
76. Ruiz M, Anguita M, Castillo JC, Delgado M, Romo E, Torres F, Mesa D, Franco M, Valles F: Pacemaker-related endocarditis: Clinical features and treatment. J Heart Valve Dis 2006; 15:122-4
77. Mansencal N, Dubourg O: Free-floating thrombus in the right heart and pulmonary embolism. Int J Cardiol 2006; 112:33-4
78. Basarici I, Yilmaz H, Demir I, Yalcinkaya S: Imminent pulmonary embolism: A fatal mobile right atrial thrombus. Int J Cardiovasc Imag 2006; 22:55-8
79. Antonini-Canterin F, Sandrini R, Pavan D, Zardo F, Nicolosi GL: Right ventricular thrombosis in arrhythmogenic cardiomyopathy. Ital Heart J 2000; 1:415-8
80. Wlodarska EK, Wozniak O, Konka M, Rydlewska-Sadowska W, Biederman A, Hoffman P: Thromboembolic complications in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. Europace 2006; 8:596-600
81. Pellett AA, Kerut EK: The Chiari network in an echocardiography student. Echocardiography 2004; 21:91-3
82. Rosenberger P, Shernan SK, Body SC, Eltzschig HK: Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism. Anesth Analg 2004; 99:12-6
83. Rosenberger P, Shernan SK, Mihaljevic T, Eltzschig HK: Transesophageal echocardiography for detecting extrapulmonary thrombi during pulmonary embolectomy. Ann Thorac Surg 2004; 78:862-6
84. Sivaram CA, Craven P, Chandrasekaran K: Transesophageal echocardiography during removal of central venous catheter associated with thrombus in superior vena cava. Am J Card Imaging 1996; 10:266-9
85. Weber T, Huemer G, Tschernich H, Kranz A, Imhof M, Sladen RN: Catheter-induced thrombus in the superior vena cava diagnosed by transesophageal echocardiography. Acta Anaesthesiol Scand 1998; 42:1227-30
86. Roe MT, Abramson MA, Li J, Heinle SK, Kisslo J, Corey GR, Sexton DJ: Clinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the Duke criteria. Am Heart J 2000; 139:945-51
87. Cabell CH, Pond KK, Peterson GE, Durack DT, Corey GR, Anderson DJ, Ryan T, Lukes AS, Sexton DJ: The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001; 142:75-80
88. Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, Vailloud JM, Derumeaux G, Gouvernet J, Ambrosi P, Lambert M, Ferracci A, Raoult D, Luccioni R: Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001; 37:1069-76
89. Deprele C, Berthelot P, Lemetayer F, Corntet C, Fresard A, Cazoria C, Fascia P, Cathebras P, Chaumentin G, Convert G, Isaaz K, Barral X, Lucht F: Risk factors for systemic emboli in infective endocarditis. Clin Microbiol infect 2004; 10:46-53
90. Vilacosta I, Graupner C, San Roman JA, Sarria C, Ronderos R, Fernandez C, Mancini L, Sanz O, Sanmartin JV, Steermann W: Risk of embolization after institution of antibiotics therapy for infective endocarditis. J Am Coll Cardiol 2002; 39:1489-95
91. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P: Neurologic manifestations of infective endocarditis: A 17 year experience in a teaching hospital in Finland. Arch Intern Med 2000; 160:2781-7
92. Karski JM: Transesophageal echocardiography in the intensive care unit. J Cardiothorac Vasc Anesth 2006; 10:162-70
93. Haldar SM, O'Gara PT: Infective endocarditis: Diagnosis and management. Nat Clin Pract Cardiovasc Med 2006; 3:310-7
94. Anguera I, Miro JM, Cabell CH, Abrutyn E, Fowler VG Jr, Hoen B, Olaison L, Pappas PA, de Lazzari E, Eykyn S, Habib G, Pare C, Wang A, Corey R, ICE-MD Investigators: Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the International Collaboration on Endocarditis Merged Database. Am J Cardiol 2005; 96:976-81
95. Anguera I, Miro JM, Vilacosta I, Almirante B, Anguita M, Roman JA, De-Alarcon A, Ripoll T, Navas E, Gonzalez-Juanatey C, Cabell CH, Sarria C, Garcia-Bolao I, Farinas MC, Leta R, Rufi G, Miralles F, Pare C, Evangelista A, Fowler VG, Mestres CA, De-Lazzari E, Guma JR, Aorto-cavitary Fistula in Endocarditis Working Group: Aorto-cavitary fistulous tract formation in infective endocarditis: Clinical and echo features of 76 cases and risk factors for mortality. Eur Heart J 2005; 26:288-97
96. Mathew J, Anand A, Addai T, Freels S: Value of echocardiographic findings in predicting cardiovascular complications in infective endocarditis. Angiology 2001; 52:801-9
97. Ragland MM, Tak T: The role of echocardiography in diagnosing space-occupying lesions of the heart. Clin Med Res 2006; 4:22-32
98. Collins NJ, Barlow MA, Woodford PA, Hayes PC: Intracardiac extension of metastatic pulmonary leiomyosarcoma. Heart Lung Circ 2005; 14:121-2
99. Gates GF, Aronsky A, Ozgur H: Intracardiac extension of lung cancer demonstrated on PET scanning. Clin Nucl Med 2006; 31:68-70
100. Parekh DJ, Cookson MS, Chapman W, Harrell JR, Wells N, Chang MS, Smith JA: Renal cell carcinoma with renal vein and inferior vena cava involvement: Clinicopathological features, surgical techniques and outcomes. J Urology 2005; 173:1897-902
101. Reck R, Speth M, Kirch Stanek M, Hedemann A, Von Mengden HJ: Vascularized atrial thrombus: A rare differential atrial myxoma diagnosis. Med Clin North Am 1996; 91:413-6
102. Pappas KD, Arnaoutoglou E, Papadopoulos G: Giant atrial septal aneurysm simulating a right atrial tumor. Heart 2004; 90:493
103. Ginon I, Mestrallet C, Barthelet M, Robin J, Andre Fouel X: A closed interatrial septum aneurysm filled with blood mimicking a tumor in the right atrium. Eur J Echocardiogr 2000; 1:289-90
104. Anfinsen OG, Aaberge L, Geiran O, Smith HJ, Aakhus S: Coronary artery aneurysms mimicking cardiac tumor. Eur J Echocardiogr 2004; 5:308-12
105. Gaudio C, Di Michele, S Cera M, Nguyen BL, Pannarale G, Alessandri N: Prominent crista terminalis mimicking a RA myxoma: Cardiac magnetic resonance aspects. Eur Rev Med Pharmacol Sci 2005; 8:165-8
106. Moinuddeen K, Marica S, Clausi RL, Zama N: Lipomatous interatrial septal hypertrophy: An unusual cause of intracardiac mass. J Thorac Cardiovasc Surg 2002; 22:468-9
107. O' Connor S, Recavarren R, Nichols LC, Parwani AV: Lipomatous hypertrophy of the interatrial septum: An overview. Arch Pathol Lab Med 2006; 130:397-9
108. Nadra I, Dawson D, Schmitz SA, Punjabi PP, Nihoyannopoulos P: Lipomatous hypertrophy of the interatrial septum: A commonly misdiagnosed mass leading to unnecessary cardiac surgery. Heart 2004; 90:66
109. Mittle S, Makaryus AN, Boutis L, Hartman A, Rosman D, Kort S: Right-sided myxomas. J Am Soc Echocardiogr 2005; 18:695
110. Sugeng L, Lang RM: Atypical cardiac myxomas. Echocardiography 2004; 21:43-7
111. Idir M, Oysel N, Guibaud JP, Labouyrie E, Roudaut R: Fragmentation of a RA myxoma presenting as a pulmonary embolism. J Am Soc Echocardiogr 2000; 13:61-3
112. Braun S, Schrotter H, Reynen K, Schwencke C, Strasser RH: Myocardial infarction as a complication of LA myxoma. Int J Cardiol 2005; 101:115-21
113. Fang BR, Chang CP, Cheng CW, Yang NI, Shieh MC, Lee N: Total detachment of cardiac myxoma causing saddle embolization and mimicking aortic dissection. Jpn Heart J 2004; 45:359-63
114. Chang YS, Chu PH, Jung SM, Lim KE, Chu JJ, Hsueh C, Lee YS: Unusual cardiac papillary fibroelastoma in the right ventricular outflow tract. Cardiovasc Pathol 2005; 14:104-6
115. Costa MJ, Makaryus AN, Rosman DR: A rare case of a cardiac papillary fibroelastoma of the pulmonary valve diagnosed by echocardiography. Int J Cardiovasc Imaging 2006; 22:199-203
116. Misawa Y, Kaminishi Y, Taguchi M: Cardiac papillary fibroelastoma. Ann Thorac Surg 2006; 82:381
117. Sun JP, Asher CR, Yang XS, Cheng GG, Scalia GM, Massed AG, Griffin BP, Ratliff NB, Stewart WJ, Thomas JD: Clinical and echocardiographic characteristics of papillary fibroelastomas: A retrospective and prospective study in 162 patients. Circulation 2001; 103:2687-93
118. Basso C, Bottio T, Valente M, Bonato R, Casarotto D, Thiene G: Primary cardiac valve tumours. Heart 2003; 89:1259-60
119. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ: Cardiac papillary fibroelastoma: A comprehensive analysis of 725 cases. Am Heart J 2003; 146:404-10
120. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC Jr, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Faxon DP, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO, ACC, AHA, ASE: ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary article. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 2003; 16:1091-110
121. Chen H, Ng V, Kane CJ, Russell IA: The role of transesophageal echocardiography in rapid diagnosis and treatment of migratory tumor embolus. Anesth Analg 2004; 99:357-9
122. Komanapalli CB, Tripathy U, Sokoloff M, Daneshmand S, Das A, Slater MS: Intraoperative renal cell carcinoma tumor embolization to the right atrium: Incidental diagnosis by transesophageal echocardiography. Anesth Analg 2006; 102:378-9
123. Kaplan S, Ekici S, Dogan R, Demircin M, Ozen H, Pasaoglu I: Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Am J Surg 2002; 183:292-9
124. Nakamura K, Asai T, Murakami M, Saito Y, Yoshimoto A, Yamaguchi H: Giant right atrial myxoma associated with tricuspid regurgitation. Jpn J Thorac Cardiovasc Surg 2006; 54:332-4
125. Eslami-Varaneh F, Brun EA, Sears-Rogan P: An unusual case of multiple fibroelastoma: Review of literature. Cardiovasc Pathol 2003; 12:170-3
126. Sadeghi N, Sadeghi S, Karimi A: Mitral valve recurrence of a left atrial myxoma. Eur J Cardiothorac Surg 2002; 21:568-73
127. Serafini O, Misuraca G, Greco F, Bisignani G, Manes MT, Venneri N: Prevalence of structural abnormalities of the atrial septum and their association with recent ischemic stroke or transient ischemic attack: Echocardiographic evaluation in 18631 patients. Ital Heart J 2003; 4:39-45
128. Payne DM, Baskett RJ, Hirsch GM: Infectious endocarditis of a Chiari network. Ann Thorac Surg 2003; 76:1303-5
129. Kizer JR, Devereux RB: Patent foramen ovale in young adults with unexplained stroke. N Engl J Med 2005; 353:2361-72
130. Kerut EK, Norfleet WT, Plotnick GD, Giles TD: Patent foramen ovale: A review of associated conditions and the impact of physiological size. J Am Coll Cardiol 2001; 38:613-23
131. Augoustides JG, Weiss SJ, Ochroch AE, Weiner J, Mancini J, Savino JS, Cheung AT: Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: Anatomic variants and correlation with patent foramen ovale. J Cardiothorac Vasc Anesth 2005; 19:146-9
132. Woods TD, Patel A: A critical review of patent foramen ovale detection using saline contrast echocardiography: When bubbles lie. J Am Soc Echocardiogr 2006; 19:215-22
133. Yoshida M, Goto S, Aikawa M, Oguma T, Nakajima T, Abe S, Kumagai A, Hoshiba Y, Tanabe T, Handa S, Yamamoto M: Detection of right to left shunting through a patent foramen ovale in Japanese patients with ischemic stroke by transesophageal echocardiography using a standardized Valsalva maneuver. Tokai J Exp Clin Med 2005; 30:211-6
134. Feigenbaum H, Armstrong WF, Ryan T: Masses, tumors, and source of embolus, Feigenbaum's Echocardiography, 6th edition. Edited by Feigenbaum H. Philadelphia: Williams & Wilkins, 2005, pp 701-34
135. Overell JR, Bone I, Less KR: Interatrial septal abnormalities and stroke: A meta-analysis of case control studies. Neurology 2000; 55:1172-9
136. Natanzon A, Goldman ME: Patent foramen ovale: Anatomy versus pathophysiology which determines stroke risk? J Am Soc Echocardiogr 2003; 16:71-6
137. Schmitt HJ, Hemmerling TM: Venous air emboli occur during release of positive end-expiratory pressure and repositioning after sitting position surgery. Anesth Analg 2002; 94:400-3
138. Coles RE, Clements FM, Lardenoye JW, Wermeskerken GV, Hey LA, Nunley JA, Levin LS, Pearsall AW IV: Transesophageal echocardiography in quantification of emboli during femoral nailing: Reamed versus unreamed techniques. J South Orthop Assoc 2000; 9:98-104
139. Yasaka M, Otsubo R, Minematsu K: Is stroke a paradoxical embolism in patients with patent foramen ovale? Intern Med 2005; 44:434-8
140. Sukernik MR, Mets B, Bennett-Guerrero E: Patent foramen ovale and its significance in the perioperative period. Anesth Analg 2001; 93:1137-46
141. Mets B: Anesthesia for left ventricular assist device placement: J Cardiothorac Vasc Anesth 2000; 14:316-26
142. Wahl A, Krumsdorf U, Meier B, Sievert H, Ostermayer S, Billinger K, Schwerzmann M, Becker U, Seiler C, Arnold M, Mattle HP, Windecker S: Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients. J Am Coll Cardiol 2005; 45:377-80
143. Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC: Short and intermediate term results of transcatheter closure of atrial septal defect with the Amplatzer septal occluder. Am Heart J 2004; 148:511-7
144. Mattioli AV, Aquilina M, Oldani A, Longhini C, Mattioli G: Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries: A multicentre study. Eur Heart J 2001; 22:261-8
145. Mattioli AV, Bonetti L, Aquilina M, Oldani A, Longhini C, Mattioli G: Association between ASA and PFO in young patients with recent stroke and normal carotid arteries. Cerebrovasc Dis 2003; 15:4-10
146. Schneider B, Hanrath P, Vogel P, Meinertz T: Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: Relation to cerebrovascular events. J Am Coll Cardiol 1990; 16:1000-9
147. Olivares-Reyes A, Chan S, Lazar EJ, Bandlamudi K, Naria V, Ong K: Atrial Septal Aneurysm: A new classification in 205 adults. J Am Soc Echocardiogr 1997; 10:644-56
148. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J: Recurrent cerebrovascular events associated with PFO, ASA, or both. N Engl J Med 2001; 345:1740-6
149. Burger AJ, Sherman HB, Charlamb MJ: Low incidence of embolic strokes with ASA: A prospective, long-term study. Am Heart J 2000; 139:149-52
150. Augoustides J, Mancini DJ, Horak J, Pochettino A, Dupont F, Dowling RD: Case 1: The use of intraoperative echocardiography during insertion of ventricular assist devices. J Cardiothorac Vasc Anesth 2003; 17:113-20
151. Schneider B, Hofmann T, Justen MH, Meinertz T: Chiari Network: Normal anatomic variant or risk factor for arterial embolic events? J Am Coll Cardiol 1995; 26:203-10
152. Becker A, Buss M, Sebening W, Meisner H, Dohlemann C: Acute inferior cardiac inflow obstruction resulting from inadvertent surgical closure of a prominent Eustachian valve. Pediatr Cardiol 1999; 20:155-7
153. Schuchlenz HW, Saurer G, Weihs W, Rehak P: Persisting Eustachian valve in adults: Relation to PFO and cerebrovascular events. J Am Soc Echocardiogr 2004; 17:231-3
154. Cooke JC, Gelman JS, Harper RW: Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device. J Am Soc Echocardiogr 1999; 12:601-3
155. Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D, Karkouti K, Beattie S, Karski J: Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesion after conventional coronary artery bypass graft surgery. Stroke 2004; 35:356-8
156. Macleod MR, Amarenco P, Davies SM, Donnan GA: Atheroma of the aortic arch: An important and poorly recognized factor in the aetiology of stroke. Lancet Neurol 2004; 3:408-14
157. Tunick PA, Kronzon I: Atheroma of the thoracic aorta: Clinical and therapeutic update. J Am Coll Cardiol 2000; 35:545-54
158. Djaiani G: Aortic arch atheroma: Stroke reduction in cardiac surgical patients. J Cardiothorac Vasc Anesth 2006; 10:143-57
159. Li YL, Wong DT, Wei W, Liu J: A new method for detecting the proximal aortic arch and innominate artery by transesophageal echocardiography. ANESTHESIOLOGY 2006; 105:226-7
160. Eltzschig HK, Kallmeyer IJ, Mihaljevic T, Alapati S, Shernan SK: A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination. J Cardiothorac Vasc Anesth 2003; 17:422-9
161. Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L, Lattuada L: The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. Eur J Cardiothorac Surg 2006; 29:720-8
162. Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF, Tonkin AM: The intraoperative assessment of ascending aortic atheroma: Epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. J Cardiothorac Vasc Anesth 1997; 11:704-7
163. Van der Linden J, Hadjinikolaou L, Bergman P, Lindblom D: Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta. J Am Coll Cardiol 2001; 38:131-5
164. Wilson MJ, Boyd SY, Lisagor PG, Rubal BJ, Cohen DJ: Ascending aortic atheroma assessed intraoperatively by epiaortic and transesophageal echocardiography. Ann Thorac Surg 2000; 70:25-30
165. Zaidat OO, Suarez JI, Hedrick D, Redline S, Schiuchter M, Landis DM, Hoit B: Reproducibility of transeosophageal echocardiography in evaluating aortic atheroma in stroke patients. Echocardiography 2005; 22:326-30
166. Fayad ZA, Nahar T, Fallon JT, Goldman M, Aguinaldo JG, Badimon JJ, Shinnar M, Chesebro JH, Fuster V: In vivo MRI evaluation of atherosclerotic plagues in the human thoracic aorta: A comparison with TEE. Circulation 2000; 101:2503-9
167. Donnan GA, Davis SM, Jones EF, Amarenco P: Aortic source of brain embolism. Curr Treat Options Cardiovasc Med 2003; 5:211-19
168. Cohen A, Amarenco P: Atherosclerosis of the thoracic aorta: From risk stratification to treatment. Am J Cardiol 2002; 90:1333-5
169. Tanaka M, Yasaka M, Nagano K, Otsubo R, Oe H, Naritomi H: Moderate atheroma of the aortic arch and the risk of stroke. Cerebrovas Dis 2006; 21:26-31
170. Di Tullio MR, Sacco RL, Savoia MT, Sciacca RR, Homma S: Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. Am Heart J 2000; 139:329-36
171. Velho FJ, Dotta F, Scherer L, Bartholomay E, Da Silva, DA Fernandes JG, Torres MA: Association between the effect of spontaneous contrast in the thoracic aorta and recent ischemic stroke determined by transesophageal echocardiography. Ar Qbras Cardiol 2004; 82:52-6
172. Kapetanakis EI, Stamou SC, Dullum MK, Hill PC, Haile E, Boyce SW, Bafi AS, Petro KR, Corso PJ: The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: A risk-adjusted study. Ann Thorac Surg 2004; 78:1564-71
173. Ura M, Sakata R, Nakayama Y, Miyamoto TA, Goto T: Ultrasound demonstration of manipulation related aortic injuries after cardiac surgery. J Am Coll Cardiol 2000; 35:1303-10
174. Stern A, Tunick PA, Culliford AT, Lachmann J, Baumann FG, Kanchuger MS, Marshall K, Shah A, Grossi E, Kronzon I: Protruding aortic arch atheroma: Risk of stroke during heart surgery with and without aortic arch endarterectomy. Am Heart J 1999; 138:746-52
175. Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J: Improving outcomes in coronary surgery: The impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. Ann Thorac Surg 2004; 78:1579-85
176. Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G, Bonatti J: Modification of surgical technique for ascending aortic atherosclerosis: Impact on stroke reduction in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003; 126:391-400
177. Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N, Uretzky G: Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. Chest 2005; 127:60-5
178. Rokkas CK, Kouchoukos NT: Surgical management of the severely atherosclerotic ascending aorta during cardiac operations. Semin Thorac Cardiovasc Surg 1998; 10:240-6
179. Sharony R, Bizekis CS, Kanchuger M, Galloway AC, Saunders PC, Applebaum R, Schwartz CF, Ribakove GH, Culliford AT, Baumann FG, Kronzon I, Colvin SB, Grossi EA: Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: A case control study. Circulation 2003; 108:15-20
180. Lev Ran O, Braunstein R, Sharony R, Kramer A, Paz Y, Mohr R, Uretzky G: No touch aorta off pump coronary surgery: The effect on stroke. J Thorac Cardiovasc Surg 2005; 129:307-13
181. Mishra M, Malhotra R, Karlekar A, Mishra Y, Trehan N: Propensity case-matched analysis of off-pump versus on-pump coronary artery bypass grafting in patients with atheromatous aorta. Ann Thorac Surg 2006; 82:608-14
182. Engelhardt M, Folkers W, Brenke C, Harders A, Fidorra H, Schmieder K: Neurosurgical operations with the patient in sitting position: Analysis of risk factors using transcranial Doppler sonography. Br J Anaesth 2006; 96:467-72
183. Domaingue CM: Neurosurgery in the sitting position: A case series. Anaesth Intensive Care 2005; 33:332-5
184. Tingleff J, Joyce FS, Pettersson G: Intraoperative echocardiographic study of air embolism during cardiac operations. Ann Thorac Surg 1995; 60:673-7
185. Chandraratna A, Ashmeg A, Pasha HC: Detection of intracoronary air embolism by echocardiography. J Am Soc Echocardiogr 2002; 15:1015-7
186. Orihashi K, Matsuura Y, Sueda T, Shikata H, Mitsui N, Sueshiro M: Pooled air in open heart operations examined by transesophageal echocardiography. Ann Thorac Surg 1996; 61:1377-80
187. Schoenburg M, Kraus B, Muehling A, Taborski U, Hoffmann H, Erhardt H, Hein S, Roth M, Vogt PR, Karliczek GF, Kloevekorn WP: The dynamic air bubble trap reduces cerebral microembolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2003; 126:1455-60
188. Borger MA, Peniston CM, Weisel RD, Vasiliou M, Green RE, Feindel CM: Neuropsychologic impairment after coronary bypass surgery: Effect of gaseous microemboli during perfusionist interventions. J Thorac Cardiovasc Surg 2001; 121:743-9
189. Madu EC, D'Cruz IA, Wall BM, Mansour N, Shearin S: Transesophageal echocardiographic spectrum of calcific mitral abnormalities in patients with end stage renal disease. Echocardiography 2000; 17:29-35
190. Marcu CB, Ghantous AE, Prokop EK: Caseous calcification of the mitral valve ring. Heart Lung Circ 2006; 15:187-8
191. Barasch E, Gottdiener JS, Larsen EK, Chaves PH, Newman AB, Manolio TA: Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly: The Cardiovascular Heath Study (CHS). Am Heart J 2006; 151:39-47
192. Kim HK, Park SJ, Suh JW, Kim YJ, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS: Association between cardiac valvular calcification and coronary artery in a low-risk population. Coron Artery Dis 2004; 15:1-6
193. Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM: Mitral and aortic annular calcifications are highly associated with systemic calcified atherosclerosis. Circulation 2006; 113:861-6
194. Bittrick J, D'Cruz IA, Wall BM, Mansour N, Mangold T: Differences and similarities between patients with and without end-stage renal disease, with regard to location of intracardiac calcification. Echocardiography 2002; 19:1-6
195. Kizer JR, Wiebers DO, Whisnant JP, Galloway JM, Welty TK, Lee ET, Best LG, Resnick HE, Roman MJ, Devereux RB: Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: The Strong Heart Study. Stroke 2005; 36:2533-7
196. Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, d'Agostino RB, Benjamin EJ: Framingham Heart Study: Mitral annular calcification predicts cardiovascular morbidity and mortality: The Framingham Heart Study. Circulation 2003; 107:1492-6
197. Willens HJ, Ferreira AC, Gallagher AJ, Morytko JA: Mobile components associated with rapidly developing mitral annulus calcification in patients with chronic renal failure: Review of mobile elements associated with mitral annulus calcification. Echocardiography 2003; 20:363-7
198. Eicher JC, Soto FX, deNadai L, Ressencourt O, Falcon-Eicher S, Giroud M, Louis P, Wolf JE: Possible association of thrombotic, nonbacterial vegetations of the mitral ring-mitral annular calcium and stroke. Am J Cardiol 1997; 79:1712-5
199. Eicher JC, DeNadal L, Soto FX, Falcon-Eicher S, Dobsak P, Zanetta G, Petit JM, Portier H, Louis P, Wolf E: Bacterial endocarditis complication mitral annular calcification: A clinical and echocardiographic study. J Heart Valve Dis 2004; 13:217-27
200. Harpaz D, Auerbach I, Vered Z, Motro M, Tobar A, Rosenblatt S: Caseous calcification of the mitral annulus: A neglected, unrecognized diagnosis. J Am Soc Echocardiogr 2001; 14:825-31
201. Ionescu AA, Newman GR, Butchart EG, Fraser AG: Morphologic analysis of a strand recovered from a prosthetic mitral valve: No evidence of fibrin. J Am Soc Echocardiogr 1999; 12:766-8
202. Homma S, Di Tullio, MR Sciacca RR, Sacco RL, Mohr JP: Effect of aspirin and warfarin therapy in stroke patients with valvular strands. Stroke 2004; 35:1436-42
203. Roldan CA, Shively BK, Crawford MH: Valve excrescences: Prevalence, evolution and risk for cardioembolism. J Am Coll Cardiol 1997; 30:1308-14
204. Dawn B, Hasnie AM, Calzada N, Longaker RA, Stoddard MF: Transesophageal echocardiography impacts management and evaluation of patients with stroke, transient ischemic attack, or peripheral embolism. Echocardiography 2006; 23:202-7