Diagnosis and assessment of thrombolytic efficacy in left atrial thrombosis using transesophageal echocardiography

: In order to evaluate the incidence of atrial thrombosis 17 patients underwent transesophageal echocardiography (TEE). They were referred to our department because of a recent systemic embolic event and we found thrombi located in the left atrial appendage in 14 patients, in 5 cases in the left atrium and in 4 cases in the right atrium. Transthoracic echocardiography showed left atrial masses in 5 patients. Transesophageal echocardiography was more sensitive than transthoracic echocardiography in detecting atrial thrombi. Fifteen patients were treated with thrombolytic therapy using urokinase or rt-PA. To evaluate the efficacy of thrombolysis, we repeated TEE immediately after the infusion and 24 hours later. We observed a reduction of the mass of thrombi in all patients; the effect of therapy was not different 24 hours later. Our study underlines the diagnostic power of TEE in detecting atrial thrombosis and also suggests the use of TEE in the evaluation of the efficacy of thrombolytic therapy.