Determination of the Optimum Number of Cardiac Cycles to Differentiate Intra-Pulmonary Shunt and Patent Foramen Ovale by Saline Contrast Two- and Three-Dimensional Echocardiography (original) (raw)
2013, Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques
Introduction: Patent foramen ovale (PFO) and intra-pulmonary shunt (IPS) are potential causes of stroke. The most optimum cardiac cycle cutoff for bubbles to appear in the left heart on saline contrast transthoracic echocardiography (TTE) as criteria to differentiate the 2 entities is unknown. Methods: Ninety-five adult patients had saline contrast transesophageal echocardiography (TEE), two-dimensional (2D) and 3DTTE. Sensitivity and specificity of each cardiac cycle as cutoff to differentiate a PFO and IPS were obtained. Results: Transesophageal echocardiography showed IPS in 28 and PFO in 15 patients. If bubbles appeared in the left heart within the first 4 cardiac cycles (the 4th cardiac cycle rule) as compared to alternate cutoffs, a PFO was most accurately diagnosed by both 2D and 3DTTE. Bubbles appearing at or after the 5th cardiac cycle most accurately determined an IPS. 3D versus 2DTTE had a trend for a higher sensitivity (61% vs. 36%, P = 0.06), but similar specificity (94% vs. 91%) for IPS. Accuracy of 3DTTE was 84% and 2DTTE was 75% (P = 0.08) for IPS. For PFO, 2DTTE sensitivity (87%) and specificity (98%) did not differ (P = NS) from that of 3DTTE sensitivity (73%) and specificity (100%). Conclusions: This study demonstrates for the first time that the 4th cardiac cycle rule differentiates PFO and IPS most optimally by 2D and 3DTTE. 3DTTE appears to have higher sensitivity for diagnosing IPS. These data suggest that 3DTTE is preferable when IPS is to be diagnosed. Both methods are similar for diagnosing PFO.
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Detection of Patent Foramen Ovale by 3D Echocardiography
JACC: Cardiovascular Imaging, 2012
Two-dimensional transesophageal echocardiography (2DTEE) with agitated saline contrast is currently the gold standard for diagnosing PFO. However, direct visualization of the bubbles crossing PFO through a septal separation is often difficult to capture by 2DTEE in a single imaging plane. Conventional 3-beat rule of bubble appearance in the left atrium after a complete right atrial opacification to differentiate PFOs from extracardiac shunts is unreliable. Valsalva maneuver often used to improve the detection of PFOs may be difficult to perform in the sedated patients during TEE.
Journal of the American College of Cardiology, 2000
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