Objective -

In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

-Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. Objective: To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism. Method: Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnorm a l i t y, underwent to TEE. Results: Ten percent were aged 45 years; or less. Left ventricle hypert ro p h y, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneury s m , mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thro mbus in left heart . Conclusion: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is undere s t i m a t e d ; atherogenic and cardioembolic causes may actually coexist, and both should be treated.KEY WORDS: stroke, cardiac embolism, transesophageal echocardiogram.E c o c a rdiograma transesofágico revela fonte cardíaca de embolia cerebral em pacientes com AVC e mais que 45 anos RESUMO -Embolia cerebral de fonte cardíaca é frequentemente relacionada a acidente vascular cerebral ( AVC) em jovem. Objetivo: D e s c rever achados ecocardiográficos em jovens e não jovens com AVC isquêmi-co, sem suspeita de fonte card í a c a . Método: Estudo transversal; 523 pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte cardíaca submeteram-se ao ecocardiograma transesofágico ( E C O T E ) . Resultados: 10% dos pacientes tinha 45 anos; ou menos. Hipert rofia do ventrículo esquerd o , aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de ateroma na aorta foram significantemente mais frequentes nos pacientes com mais que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas. Conclusão: ECOTE é amplamente sugerido na investigação de embolia em pacientes jovens, porém parece ser tão importante também no grupo de pacientes mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e tratadas para melhor prognóstico. PALAVRAS-CHAVE: acidente vascular cerebral, embolia cardíaca, ecocardiograma transesofágico.

No abstract

Different vascular abnormalities have been reported under the denomination of "persistence of the fifth aortic arch." Detailed studies on experimental embryology raised the discussion about the existence of the fifth aortic arch as an embryological structure, both in humans and mammals. In 1969 the Van Praaghs described the occurrence of double left aortic arch, denominating such anomaly as persistence of the fifth arch. We describe here a female patient showing the presence of an anomalous vessel in parallel with the aortic arch. The finding was occasional, during a preoperative evaluation for cholecystectomy.