Transesophageal Echocardiography in the Detection of Potential Cardiac Source of Embolism in Embolic Stroke of Undetermined Source: A Preliminary Study

Background: Embolic stroke of undetermined source (ESUS) occurs when the recommended diagnostic workup fails to identify a convincing underlying cause. ESUS is more common among male patients of younger age. One of the most common underlying findings among ESUS patients is a patent foramen ovale (PFO). Transesophageal echocardiography (TEE) offers enhanced diagnostic information for certain patients due to its proximity to the heart and major vessels, making it superior to transthoracic echocardiography in various conditions.Objectives: To assess the diagnostic yield of the TEE in young patients with ischemic stroke who fulfil the diagnostic criteria of ESUS.Materials and Methods: This was a descriptive-observational cross-sectional study. It was conducted at Shaheed Al-Mehrab Center for Cardiac Catheterization from January 2, 2024, to June 1, 2024. The study included young patients with ischemic stroke, referred by their treating neurologist, who fulfilled ESUS diagnostic criteria and underwent TEE. We designed a specific questionnaire to document relevant information.Results: -A total of 13 patients were enrolled in the current study. The mean age was 36.77 ± 4.88 years, with the majority of cases (n = 8) being males. Among patients with ESUS, TEE detected PFO in 23.1% and atrial septal aneurysm in 15.4%. All patients had normal left atrial appendage (LAA) parameters and ejection fraction. The mean body mass index was significantly lower in patients with PFO. The mean of early and late LAA emptying velocities were significantly lower in patients with PFO.Conclusion: TEE was effective in identifying underlying cardiac abnormalities in ESUS patients, with a significant detection rate for PFO and atrial septal defects. We recommend further studies with larger sample sizes to confirm the study's results.