Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study

Ann Intern Med. 1995 Dec 1;123(11):817-22. doi: 10.7326/0003-4819-123-11-199512010-00001.


Objective: To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi.

Design: Prospective cohort study.

Setting: University hospital.

Patients: 231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism.

Measurement: Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery.

Results: Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size range from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery.

Conclusion: Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Echocardiography, Transesophageal*
  • Female
  • Heart Atria / diagnostic imaging*
  • Humans
  • Intraoperative Period
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Thrombosis / diagnostic imaging*