Modified Method of Contrast Transthoracic Echocardiography for the Diagnosis of Patent Foramen Ovale

Enfa Zhao, Yajuan Du, Hang Xie, Yushun Zhang, Enfa Zhao, Yajuan Du, Hang Xie, Yushun Zhang

Abstract

Purpose: To compare the sensitivity and specificity of modified and traditional methods of contrast echocardiography of the right portion of the heart in patients with a suspicion of patent foramen ovale (PFO).

Methods: The study population consisted of 506 patients with high clinical suspicion of PFO. The traditional Valsalva maneuver consists of expiration against a closed glottis after a full inspiration. A modified Valsalva maneuver was performed with a handmade pressure monitoring device, which measured pressure during performance of the Valsalva maneuver. Modified and traditional methods of contrast echocardiography were performed among all patients. Contrast transesophageal echocardiography (TEE) was regarded as the gold standard.

Results: A total of 279 patients with PFO were confirmed by TEE. 259 cases (sensitivity: 92.83%) were detected by a modified method of contrast echocardiography of the right portion of the heart, while 234 cases were detected using the traditional method (sensitivity: 83.87%). The sensitivity of modified contrast echocardiography of the right portion of the heart was significantly higher than that of the traditional method (92.83% vs. 83.87%, P=0.001). However, there was no significant difference in the specificity of the two methods for the diagnosis of PFO (97.35% vs. 96.03%, P=0.431). Additionally, the results of semiquantitative evaluation of PFO using modified method failed to show a more positive rate than shown by the traditional method (Z=-1.782, P=0.075).

Conclusions: Modified contrast echocardiography of the right portion of the heart yielded a higher sensitivity than the traditional method, which contributed to the diagnosis of cardiac PFO. The research was a part of a register study (https://register.clinicaltrials.gov/ ClinicalTrials ID: NCT02777359).

Figures

Figure 1
Figure 1
Handmade pressure monitoring device.
Figure 2
Figure 2
(a) Two-dimensional TEE displaying a “slit-like” channel between the left and right atria, revealing the presence of a PFO. (b) Doppler color flow imaging showing spontaneous PFO-left-to-right shunt. (c) TEE bubble study showing the microbubbles passing through the PFO.

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