• W J Manning, R M Weintraub, C A Waksmonski, J M Haering, P S Rooney, A D Maslow, R G Johnson, and P S Douglas.
• Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215, USA.
• Ann. Intern. Med. 1995 Dec 1; 123 (11): 817-22.

ObjectiveTo determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi.DesignProspective cohort study.SettingUniversity hospital.Patients231 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.MeasurementIdentification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery.ResultsTransesophageal 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.ConclusionTransesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.

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