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P594Contrast transthoracic echocardiography as a gatekeeper for patent foramen ovale closure

M Muratori1, G Italiano1, E Innocenti1

  • 1Centro Cardiologico Monzino IRCCS, Milan, Italy.

European Heart Journal. Cardiovascular Imaging
|April 18, 2017
PubMed

Insights

Contrast transthoracic echocardiography (TTE) with agitated saline effectively identifies patent foramen ovale (PFO). This contrast-TTE serves as a primary screening tool for patients needing PFO closure, guiding clinical decisions.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Patent foramen ovale (PFO) is linked to cryptogenic stroke, TIA, migraine, and decompression sickness.
  • Transesophageal echocardiography is the gold standard for PFO visualization but is invasive and costly.
  • Standard transthoracic echocardiography (TTE) lacks sufficient sensitivity for PFO screening.

Purpose of the Study:

  • To evaluate contrast-enhanced transthoracic echocardiography (contrast-TTE) as a gatekeeper for PFO identification.
  • To assess the role of contrast-TTE in patient selection for percutaneous PFO closure.

Main Methods:

  • 200 patients underwent contrast-TTE at rest and with provocative maneuvers (Valsalva).
  • Contrast levels were graded 0-4 based on bubble counts and LV opacification.
  • Percutaneous PFO closure decisions were based on comprehensive imaging, clinical evaluation, and thrombophilia screening.

Main Results:

  • Contrast-TTE with provocative maneuvers detected PFO in 47% of patients, compared to 17% at rest.
  • Interatrial septal aneurysms were present in 14% of patients.
  • PFO closure was performed in 17% of patients, all with severe shunting (grade ≥3) on contrast-TTE.

Conclusions:

  • Contrast-TTE with provocative maneuvers is an accurate tool for PFO detection.
  • Contrast-TTE can be integrated into the diagnostic work-up as a primary gatekeeper for percutaneous closure.
  • The severity of shunting identified by contrast-TTE significantly influences PFO closure decisions.
Abstract

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