Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale

Abstract

We directly compared the utility of agitated saline solution contrast echocardiography and color flow Doppler with both transthoracic and transesophageal echocardiography in the detection of patient foramen ovale (PFO). Forty-three patients referred for contrast echocardiography and transesophageal echocardiography were prospectively studied. Three were excluded because of technically inadequate contrast, and two were excluded because of hemodynamically significant atrial septal defect. The remaining 38 patients, who ranged in age from 19 to 73 years, were referred for cerebrovascular events (31), peripheral embolus (5), atrial septal aneurysm (1), and suspected atrial septal defect (1). With either contrast or color flow Doppler, PFO was detected by transthoracic imaging in 9 (24%) of 38 patients compared with 20 (53%) of 38 with transesophageal echo. PFO was present in 1 (3%) of 38 by TTE color flow, 9 (24%) of 38 by TTE contrast, 17 (45%) of 38 by TEE color flow, and 14 (37%) of 38 by TEE contrast. Discordant findings with TEE were the result of contrast-positive, color-negative results in 3 patients and color-positive, contrast-negative results in 6. With TEE contrast used as a diagnostic gold standard, other techniques detected PFO with the following sensitivities, specificities, and positive and negative predictive values: TEE color flow 79%, 75%, 65%, 86%, respectively; TTE contrast 50%, 92%, 78%, 76%, respectively; and TTE color flow 7%, 100%, 50%, 65%, respectively. Thus PFO is detected more frequently with TEE. TEE contrast and color flow Doppler yielded discordant findings in a minority of patients, probably as a result of intrinsic limitations in each technique.(ABSTRACT TRUNCATED AT 250 WORDS)