Patent foramen ovale echocardiography
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [3]
Overview
Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and transcranial Doppler (TCD) are the commonly used diagnostic tools for patent foramen ovale[1]. Each method has its own advantage and disadvantages in diagnosing patent foramen ovale. Transesophageal echocardiography is more sensitive in visualizing the interatrial septum, than transthoracic echocardiography and is the imaging modality of choice. Patients with clinical suspicion of patent foramen ovale and negative results with transthoracic echocardiography should be referred for a transesophageal echocardiography [2][3]. Transthoracic echocardiography (TTE) with contrast at rest, with cough, and after valsalva maneuver is generally considered the most definitive diagnostic test for patent foramen ovale. The performance of a bubble study on echocardiography is especially useful with small patent foramen ovale.
Echocardiography
Transesophageal Echocardiography
- It is the imaging study of choice in adults with suspected paradoxical embolism.[4]
- It may be difficult to use when diagnosing right-to-left shunts with contrast echocardiography because sedation makes valsalva maneuver more difficult to perform.[4]
Advantage
- Gold standard in diagnosing patent foramen ovale.
- It detects other associated lesions like aortic atheroma, left atrial appendage thrombus and spontaneous left atrial contrast. Thus, helps in finding other occult causes for stroke.
Transthoracic Echocardiography
Advantage
- Bubble test gives better results with transthoracic echocardiography as the patient is in semi-upright position and is able to perform the valsalva maneuver.
Disadvantage
- Poor image quality can lead to missing some of the patent foramen ovale.
Contrast Echocardiography
- It is used in detecting the presence of a right-to-left shunt across a patent foramen ovale. This is done by injecting a contrast medium into a peripheral vein. During the strain phase of the valsalva maneuver, the contrast is injected and the atrial septum is imaged during the release phase of the maneuver.[4]
- If at least three contrast bubbles appear in the left atrium, a patent foramen ovale is said to be present.[4]
Transcranial Doppler
Advantage
- Patient is able to perform valsalva maneuver.
- Good image quality.
Disadvantage
- Cannot differentiate between different inter-atrial defects like patent foramen ovale (PFO), atrial septal defect (ASD). If transcranial doppler detects a inter-atrial defect then the other details about the site of the shunt, and the presence of associated features such as atrial septal aneurysm etc has to be done by a follow-up transesophageal echocardiography.
References
- ↑ Sastry S, Daly K, Chengodu T, McCollum C (2007). "Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible?". Cerebrovasc Dis. 23 (5–6): 424–9. doi:10.1159/000101466. PMID 17406112.
- ↑ Thanigaraj S, Valika A, Zajarias A, Lasala JM, Perez JE (2005). "Comparison of transthoracic versus transesophageal echocardiography for detection of right-to-left atrial shunting using agitated saline contrast". Am J Cardiol. 96 (7): 1007–10. doi:10.1016/j.amjcard.2005.05.061. PMID 16188533.
- ↑ Van Camp G, Franken P, Melis P, Cosyns B, Schoors D, Vanoverschelde JL (2000). "Comparison of transthoracic echocardiography with second harmonic imaging with transesophageal echocardiography in the detection of right to left shunts". Am J Cardiol. 86 (11): 1284–7, A9. PMID 11090813.
- ↑ 4.0 4.1 4.2 4.3 Pinto FJ (2005). "When and how to diagnose patent foramen ovale". Heart. 91 (4): 438–40. doi:10.1136/hrt.2004.052233. PMC 1768819. PMID 15772190.