Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

• Published in: Journal of the American Society of Echocardiography Vol. 29; no. 1; pp. 1 - 42
• Main Authors: Saric, Muhamed, MD, PhD, FASE, Armour, Alicia C., MA, BS, RDCS, FASE, Arnaout, M. Samir, MD, Chaudhry, Farooq A., MD, FASE, Grimm, Richard A., DO, FASE, Kronzon, Itzhak, MD, FASE, Landeck, Bruce F., MD, FASE, Maganti, Kameswari, MD, FASE, Michelena, Hector I., MD, FASE, Tolstrup, Kirsten, MD, FASE
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2016
• Subjects: Aortic atherosclerosis; Cardiac mass; Cardiac shunt; Cardiac tumor; Cardioembolism; Cardiovascular; Cryptogenic stroke; Diagnosis, Differential; Echocardiography, Transesophageal - standards; Heart Diseases - complications; Heart Diseases - diagnostic imaging; Humans; Intracardiac thrombus; Practice Guidelines as Topic; Prosthetic valve; Thromboembolism - diagnosis; Thromboembolism - etiology; Vegetation; ATS; NBTE; Cholesterol emboli syndrome; Parasternal short axis; LV; PFE; Papillary fibroelastoma; Mitral annular calcification; Nonbacterial thrombotic endocarditis; Computed tomography; Spontaneous echocardiographic contrast; PLAX; Cryptogenic stroke; Infective endocarditis; PFO; Left atrial appendage; IE; Right atrium; Arteriovenous malformation; Mitral valve; Atrial septal aneurysm; Transthoracic echocardiography; VSD; Intracardiac thrombus; MV; Transcatheter aortic valve replacement; MAC; RA; CES; SEC; TCD; Cardioembolism; Vegetation; AVM; American Society of Echocardiography; Transesophageal echocardiography; Transient ischemic attack; RV; TTE; MRI; Two-dimensional; Cardiac mass; Left atrium; TAVR; ASA; 2D; ASD; Prosthetic valve; ASE; Atrial septal defect; ventricular septal defect; Parasternal long-axis; PSAX; Aortic thromboembolism syndrome; Right ventricle; Cardiac tumor; Patent foramen ovale; Aortic atherosclerosis; LAA; Transcranial Doppler; TIA; Cardiac shunt; Left ventricle; Pulmonary embolism; 3D; CT; Three-dimensional; Magnetic resonance imaging; LA; PE; TEE
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2015.09.011

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.