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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Is transesophageal echocardiography still necessary to exclude patent foramen ovale?

M Zuber1, F Cuculi, E Oechslin

  • 1Division of Cardiology, Kantonsspital Luzern, Luzern, Switzerland. michel.zuber@bluewin.ch

Scandinavian Cardiovascular Journal : SCJ
|June 24, 2008
PubMed

Insights

High-end transthoracic echocardiography (TTE) accurately detects interatrial shunts, including patent foramen ovale (PFO), using contrast. This may establish TTE as a preferred diagnostic method over transesophageal echocardiography (TEE).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Current guidelines recommend transesophageal echocardiography (TEE) as the gold standard for diagnosing interatrial shunts.
  • There is a need to evaluate alternative, less invasive diagnostic methods.

Purpose of the Study:

  • To assess the accuracy of high-end transthoracic echocardiography (TTE) in excluding interatrial shunts.
  • To compare TTE with TEE for shunt detection.

Main Methods:

  • Prospective study involving both TTE and TEE with second harmonic imaging.
  • Utilized color Doppler and contrast echocardiography to detect left-to-right (L/R) or right-to-left (R/L) shunts.
  • Included patients with unexplained cerebrovascular incidents or new valvular/myocardial disease.

Main Results:

  • An interatrial shunt was identified in 200 out of 438 patients (45.7%).
  • Contrast echocardiography with a Valsalva maneuver detected 95% of shunts using both TTE and TEE.
  • TTE uniquely identified 5% of shunts that were missed by TEE.

Conclusions:

  • High-end transthoracic contrast-echocardiography can reliably demonstrate patent foramen ovale (PFO).
  • TTE shows potential to become the preferred diagnostic method for PFO.
  • Further studies are warranted to confirm these findings.
Abstract

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