Overcoming a stubborn patent foramen ovale

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Transesophageal echocardiography (TEE) with agitated saline contrast is standard for patent foramen ovale (PFO) detection.
• Provocative maneuvers aid PFO diagnosis but can be challenging during TEE.
• Preprocedural fasting can cause hypovolemia, potentially hindering PFO detection.

Observation:

• A 57-year-old male with cryptogenic stroke had a persistent PFO.
• The PFO was difficult to detect during a TEE bubble study.
• The PFO only became apparent after significant fluid replenishment and passive leg raise (PLR).

Findings:

• Hypovolemia from fasting can reduce the sensitivity of TEE bubble studies for PFO.
• Fluid replenishment combined with PLR can optimize conditions for PFO detection via TEE.
• This case highlights a specific patient where enhanced hydration was crucial for PFO diagnosis.

Implications:

• Optimizing hydration status and utilizing maneuvers like PLR may be essential for accurate PFO diagnosis in TEE.
• This approach could improve detection rates in patients with challenging PFO cases.
• Consideration of preprocedural hydration status is important for TEE-guided PFO evaluation.