Patent foramen ovale echocardiography and ultrasound: Difference between revisions
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*When diagnosing patent foramen ovale, transesophageal echocardiography (TEE) is preferred over transthoracic echocardiography (TTE). It has a superior image resolution and the ability to identify the origin of a right-to-left shunt. It is the study of choice in patients suspected to have a paradoxical embolus.<ref name="pmid1987242">{{cite journal| author=Pearson AC, Labovitz AJ, Tatineni S, Gomez CR| title=Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. | journal=J Am Coll Cardiol | year= 1991 | volume= 17 | issue= 1 | pages= 66-72 | pmid=1987242 | doi=10.1016/0735-1097(91)90705-e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987242 }} </ref><ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="pmid28465918">{{cite journal| author=Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C| title=How to Understand Patent Foramen Ovale Clinical Significance: Part I. | journal=J Cardiovasc Echogr | year= 2014 | volume= 24 | issue= 4 | pages= 114-121 | pmid=28465918 | doi=10.4103/2211-4122.147202 | pmc=5353567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465918 }} </ref> | *When diagnosing patent foramen ovale, transesophageal echocardiography (TEE) is preferred over transthoracic echocardiography (TTE). It has a superior image resolution and the ability to identify the origin of a right-to-left shunt. It is the study of choice in patients suspected to have a paradoxical embolus.<ref name="pmid1987242">{{cite journal| author=Pearson AC, Labovitz AJ, Tatineni S, Gomez CR| title=Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. | journal=J Am Coll Cardiol | year= 1991 | volume= 17 | issue= 1 | pages= 66-72 | pmid=1987242 | doi=10.1016/0735-1097(91)90705-e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987242 }} </ref><ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="pmid28465918">{{cite journal| author=Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C| title=How to Understand Patent Foramen Ovale Clinical Significance: Part I. | journal=J Cardiovasc Echogr | year= 2014 | volume= 24 | issue= 4 | pages= 114-121 | pmid=28465918 | doi=10.4103/2211-4122.147202 | pmc=5353567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465918 }} </ref> | ||
*The process of detecting a right-to-left shunt across a PFO involves the patient performing the valsalva maneuver while injected with a saline contrast medium. During the strain phase of the maneuver, the saline medium is injected into a peripheral vein and the atrial septum is visualized during the release phase of the maneuver.<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref> | *The process of detecting a right-to-left shunt across a PFO involves the patient performing the valsalva maneuver while injected with a saline contrast medium. During the strain phase of the maneuver, the saline medium is injected into a peripheral vein and the atrial septum is visualized during the release phase of the maneuver.<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref> | ||
*Although tranesopheageal echocardiography is preferred, sedating the patient may | *Although tranesopheageal echocardiography is preferred, sedating the patient may cause difficulty in performing the valsalva maneuver.<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref> | ||
*Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="MasArquizan2001">{{cite journal|last1=Mas|first1=Jean-Louis|last2=Arquizan|first2=Caroline|last3=Lamy|first3=Catherine|last4=Zuber|first4=Mathieu|last5=Cabanes|first5=Laure|last6=Derumeaux|first6=Geneviève|last7=Coste|first7=Joël|title=Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both|journal=New England Journal of Medicine|volume=345|issue=24|year=2001|pages=1740–1746|issn=0028-4793|doi=10.1056/NEJMoa011503}}</ref> | *Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="MasArquizan2001">{{cite journal|last1=Mas|first1=Jean-Louis|last2=Arquizan|first2=Caroline|last3=Lamy|first3=Catherine|last4=Zuber|first4=Mathieu|last5=Cabanes|first5=Laure|last6=Derumeaux|first6=Geneviève|last7=Coste|first7=Joël|title=Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both|journal=New England Journal of Medicine|volume=345|issue=24|year=2001|pages=1740–1746|issn=0028-4793|doi=10.1056/NEJMoa011503}}</ref> | ||
:*Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycle after the complete opacification of the right atrium. | :*Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycle after the complete opacification of the right atrium. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Overview
Echocardiography/Ultrasound
- When diagnosing patent foramen ovale, transesophageal echocardiography (TEE) is preferred over transthoracic echocardiography (TTE). It has a superior image resolution and the ability to identify the origin of a right-to-left shunt. It is the study of choice in patients suspected to have a paradoxical embolus.[1][2][3]
- The process of detecting a right-to-left shunt across a PFO involves the patient performing the valsalva maneuver while injected with a saline contrast medium. During the strain phase of the maneuver, the saline medium is injected into a peripheral vein and the atrial septum is visualized during the release phase of the maneuver.[2]
- Although tranesopheageal echocardiography is preferred, sedating the patient may cause difficulty in performing the valsalva maneuver.[2]
- Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:[2][4]
- Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycle after the complete opacification of the right atrium.
References
- ↑ Pearson AC, Labovitz AJ, Tatineni S, Gomez CR (1991). "Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology". J Am Coll Cardiol. 17 (1): 66–72. doi:10.1016/0735-1097(91)90705-e. PMID 1987242.
- ↑ 2.0 2.1 2.2 2.3 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.
- ↑ Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C (2014). "How to Understand Patent Foramen Ovale Clinical Significance: Part I." J Cardiovasc Echogr. 24 (4): 114–121. doi:10.4103/2211-4122.147202. PMC 5353567. PMID 28465918.
- ↑ Mas, Jean-Louis; Arquizan, Caroline; Lamy, Catherine; Zuber, Mathieu; Cabanes, Laure; Derumeaux, Geneviève; Coste, Joël (2001). "Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both". New England Journal of Medicine. 345 (24): 1740–1746. doi:10.1056/NEJMoa011503. ISSN 0028-4793.