A large Eustachian valve is a confounder of contrast but not of color Doppler transesophageal echocardiography in detecting a right-to-left shunt across a patent foramen ovale
A large Eustachian valve is a confounder of contrast but not of color Doppler transesophageal echocardiography in detecting a right-to-left shunt across a patent foramen ovale
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DOI：
10.1016/j.ijcard.2005.06.022
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发表时间：
2006-05-24
影响因子：
3.5
通讯作者：
Rehak, P
中科院分区：
文献类型：
--
作者：
Schuchlenz, HW;Weihs, W;Rehak, P
背景：经食管超声造影（cTEE）被认为是诊断卵圆孔未闭（PFO）的首选方法，但其诊断准确性与彩色多普勒引导TEE在耳咽管瓣膜（EV）存在下的比较尚未得到评估。本研究的主要目的是评估低脉冲重复频率下彩色多普勒TEE的PFO诊断准确性。方法：我们对292例（年龄42 - 12岁）隐源性脑卒中患者采用cTEE和经胸超声造影（cTTE）确定PFO和EV的存在。PFO的诊断是基于观察造影剂泡从右到左分流或彩色多普勒脉冲重复频率为20-30 cm/s。双侧位上直径为> ~ 1.5 cm的肠内瘘被认为是大的。结果：总体204例患者（70%）通过对比回声方法有右至左分流的证据。彩色多普勒比cTEE更频繁地显示分流，要么是自发的（133比92，p=0.01），要么是在挑衅演习中（166比184，p=0.01）。彩色多普勒的灵敏度明显高于cTEE （90% vs. 81%; p=0.01）。37例患者发现大EV，其中31例（84%）为PFO。大EV的存在对彩色多普勒通过PFO检测分流的灵敏度没有显著影响，但cTTE和cTEE的灵敏度显著降低（从88%降至42%，p < 0.001）。结论：如果使用低脉冲重复频率，彩色多普勒TEE比传统cTEE更准确地诊断PFO，并且不受EV存在的负面影响。2005爱思唯尔爱尔兰有限公司版权所有。
Background: Transesophageal contrast echocardiography (cTEE) is considered to be the method of choice for diagnosing patent foramen ovale (PFO), but its diagnostic accuracy compared with color Doppler guided TEE in the presence of an Eustachian valve (EV) has not been evaluated. The main aim of this study was to assess the diagnostic accuracy for PFO diagnosis of color Doppler TEE at low pulse repetition frequency.Methods: We ascertained the presence of PFO and EV using cTEE and transthoracic contrast echocardiography (cTTE) in 292 consecutive patients (age 42 12 years) with cryptogenic stroke. A diagnosis of PFO was based on the observation of right-to-left shunting of contrast bubbles or by color Doppler with pulse repetition frequency of 20-30 cm/s. An EV with a diameter of > 1.5 cm in the bicaval view was considered large.Results: Overall 204 patients (70%) had evidence of a right-to-left shunt by either contrast echo method. Shunting was demonstrated more frequently by color Doppler than by cTEE, either spontaneously (133 vs. 92; p=0.01) or during provocative maneuvers (166 vs. 184,p=0.01). The sensitivity of color Doppler was significantly higher than that of cTEE (90% vs. 81%; p=0.01). A large EV was found in 37 patients, 31 (84%) of whom had a PFO. The presence of a large EV did not significantly influence the sensitivity of color Doppler for detecting shunting through a PFO, but the sensitivity of cTTE and cTEE was significantly reduced (from 88% to 42%, p < 0.001).Conclusions: Color Doppler TEE is more accurate than traditional cTEE for PFO diagnosis and is not negatively influenced by the presence of an EV, provided that a low pulse repetition frequency is used. (c) 2005 Elsevier Ireland Ltd. All rights reserved.