Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients

J Cardiothorac Vasc Anesth. 2004 Dec;18(6):725-30. doi: 10.1053/j.jvca.2004.08.009.

Abstract

Objective: To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection.

Design: A prospective observational study.

Setting: University hospital (single institution).

Participants: Patients presenting for cardiac surgery requiring TEE.

Interventions: Multiplane TEE including 2 atrial views with color-flow Doppler (CFD) and contrast echocardiography (CE) with a provocative respiratory maneuver (PRM) and comparison of multiplane TEE and VI with respect to PFO detection.

Measurements and main results: The cohort size was 187. PFO prevalence was 27.3%. CFD with serial decrease of the Nyquist limit detected 51% of all PFO: 41.2% in the bicaval view alone, 27.5% in the 4-chamber view alone, and 9.8% in both views. CE detected 78.4% of all PFO: 72.5% with PRM, 45.1% with no PRM, and 27.4% with/without PRM. PFO detection by multiplane TEE and visual inspection were correlated in 41 subjects. TEE diagnosed 11 PFO (26.8% prevalence, 3 missed by VI). VI diagnosed 12 PFO (29.3% prevalence, 4 missed by TEE).

Conclusions: Multiplane TEE is a gold standard for detection of PFO. Despite advances in TEE technology, 2-dimensional imaging does not detect all PFO. To maximize PFO detection, multiple TEE modalities are required in multiple views, despite a low Nyquist limit for CFD or a PRM for CE. Even though multiplane TEE is equivalent to VI for PFO detection, the discrepancy rate may be an important consideration in the individual case.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Cardiac Surgical Procedures / methods*
  • Cohort Studies
  • Echocardiography / methods
  • Echocardiography, Doppler, Color / methods
  • Echocardiography, Transesophageal / methods*
  • Female
  • Heart Septal Defects, Atrial / diagnosis*
  • Heart Septal Defects, Atrial / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Reproducibility of Results