Is there a hemispheric side preference of cardiac valvular emboli?

Microaggregates arising from prosthetic cardiac valves offer the opportunity to examine the distribution of valvular emboli in the human cerebral circulation. Forty-four patients with different kinds of prosthetic valves underwent bilateral transcranial Doppler monitoring for 1 h to detect high intensity Doppler signals representing microemboli. Comparing the total number of embolic signals in both middle cerebral arteries (N = 1066), a side preference was not statistically evident. However, clear side preferences were obvious in some individuals. The lack of statistical evidence for hemispherical preferences of cardiac microembolism in general does not exclude selective streaming in individuals, explaining the clinical observation of lodging preferences of recurrent cardiac embolism. A cardiac source of microembolism may mimic disease activity of extracranial carotid artery stenosis and bias the localization of embolic source.