This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schuchlenz, H. W. Articles by Rehak, P. Search for Related Content PubMed PubMed Citation Articles by Schuchlenz, H. W. Articles by Rehak, P. Related Collections Cardiovascular imaging agents/Techniques Catheter-based coronary and valvular interventions: other Echocardiography Embolic stroke Pathology of Stroke

(Stroke. 2002;33:293.)
© 2002 American Heart Association, Inc.

Short Communications

Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events

Herwig W. Schuchlenz, MD; Wolfgang Weihs, MD; Albrecht Beitzke, MD; Jörg-Ingolf Stein, MD; Andreas Gamillscheg, MD Peter Rehak, PhD

From the Second Department of Medicine (H.W.S., W.W.), Department of Pediatrics (A.B., J-I.S., A.G.), and Division of Medical Engineering and Computing, Department of Surgery (P.R.), Landeskrankenhaus-Universitätsklinikum Graz, Graz, Austria.

Correspondence to Herwig W Schuchlenz, MD, 2 Medizinische Abteilung, LKH-Universitätsklinikum Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. E-mail herwig.schuchlenz{at}klinikum-graz.at

Abstract

Background and Purpose— Patent foramen ovale (PFO) is a risk factor for paradoxical embolism, and severe shunting and wide opening of PFO are risk factors for severe and recurrent cerebrovascular events. Neither contrast echocardiography nor 2-dimensional (2D) measurement of PFO size have been validated or compared with invasive balloon sizing.

Methods— We performed transesophageal echocardiography (TEE) in 100 patients with cryptogenic stroke and catheter closure of PFO. The amount of contrast shunting through the PFO during cubital and femoral contrast delivery and the PFO size measured by 2D TEE were compared with balloon sizing.

Results— There was a significant correlation (r²=0.8; P<0.0001) between 2D TEE measurement and invasive balloon sizing. Mean balloon-sized PFO diameter was significantly larger than mean PFO diameter measured by 2D TEE (8.3±2.6 versus 5.2±1.7 mm). Semiquantitative contrast TEE correlated with PFO size (r²=0.7; P<0.0001) only if the contrast agent was administered through a femoral vein. Correlation was poor when the contrast agent was administered via a cubital vein.

Conclusions— We conclude that 2D TEE measurement of a PFO size is more accurate than the traditionally used contrast technique.

Key Words: cerebral ischemia • contrast media • echocardiography, transesophageal • embolism, paradoxical • foramen ovale, patent

This article has been cited by other articles:

				S. R. Messe and S. E. Kasner Patent Foramen Ovale in Cryptogenic Stroke: Not to Close Circulation, November 4, 2008; 118(19): 1999 - 2004. [Full Text] [PDF]

				D. Saura, G. de la Morena, and M. Valdes-Chavarri Femoral versus antecubital vein contrast injection Eur J Echocardiogr, December 1, 2007; 8(6): 416 - 417. [Full Text] [PDF]

				M. R. Sukernik and E. Bennett-Guerrero The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? A Core Review Anesth. Analg., September 1, 2007; 105(3): 602 - 610. [Abstract] [Full Text] [PDF]

				M. C. Johansson, P. Eriksson, Y. Peker, J. Hedner, L. Rastam, and U. Lindblad The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea Eur. Respir. J., January 1, 2007; 29(1): 149 - 155. [Abstract] [Full Text] [PDF]

				M. Schwerzmann, K. Nedeltchev, F. Lagger, H. P. Mattle, S. Windecker, B. Meier, and C. Seiler Prevalence and size of directly detected patent foramen ovale in migraine with aura Neurology, November 8, 2005; 65(9): 1415 - 1418. [Abstract] [Full Text] [PDF]

				S. Homma and R. L. Sacco Patent Foramen Ovale and Stroke Circulation, August 16, 2005; 112(7): 1063 - 1072. [Full Text] [PDF]

				F J Pinto When and how to diagnose patent foramen ovale Heart, April 1, 2005; 91(4): 438 - 440. [Full Text] [PDF]

				O. K. Mohrs, S. E. Petersen, D. Erkapic, C. Rubel, R. Schrader, B. Nowak, W. A. Fach, H.-U. Kauczor, and T. Voigtlaender Diagnosis of Patent Foramen Ovale Using Contrast-Enhanced Dynamic MRI: A Pilot Study Am. J. Roentgenol., January 1, 2005; 184(1): 234 - 240. [Abstract] [Full Text] [PDF]

				M. A. Topcuoglu, H. P. Mattle, B. Meier, S. Windecker, for the PC Trial Group, S. R. Messe, S. Homma, and S. E. Kasner Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, December 14, 2004; 63(11): 2198 - 2199. [Full Text] [PDF]

				H. W. Schuchlenz, G.P. Anzola, E. Morandi, F. Casilli, and E. Onorato Contrast Ultrasound Techniques in the Detection and Quantification of Patent Foramen Ovale: Myth Versus Reality * Response: Stroke, December 1, 2004; 35(12): 2755 - 2756. [Full Text] [PDF]

				G.P. Anzola, E. Morandi, F. Casilli, and E. Onorato Does Transcatheter Closure of Patent Foramen Ovale Really "Shut the Door?": A Prospective Study With Transcranial Doppler Stroke, September 1, 2004; 35(9): 2140 - 2144. [Abstract] [Full Text] [PDF]

				N.R.A Clarke, J Timperley, A.D Kelion, and A.P Banning Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts Eur J Echocardiogr, June 1, 2004; 5(3): 176 - 181. [Abstract] [Full Text] [PDF]

				G. P. Anzola Transcranial Doppler: Cinderella in the Assessment of Patent Foramen Ovale in Stroke Patients Stroke, June 1, 2004; 35(6): e137 - e137. [Full Text] [PDF]

				H. W. Schuchlenz Patent Foramen Ovale and Stroke Stroke, June 1, 2004; 35(6): e135 - e136. [Full Text] [PDF]

				M Braun, V Gliech, A Boscheri, S Schoen, G Gahn, H Reichmann, M Haass, R Schraeder, and R.H Strasser Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: Periprocedural safety and mid-term follow-up results of three different device occluder systems Eur. Heart J., March 1, 2004; 25(5): 424 - 430. [Abstract] [Full Text] [PDF]

				M. J Landzberg and P. Khairy Indications for the closure of patent foramen ovale Heart, February 1, 2004; 90(2): 219 - 224. [Full Text] [PDF]

				H. P. Adams Jr Patent Foramen Ovale: Paradoxical Embolism and Paradoxical Data Mayo Clin. Proc., January 1, 2004; 79(1): 15 - 20. [PDF]

				J. R. Corboy, H. W. Schuchlenz, G. Saurer, W. Weihs, W. Lalouschek, the Vienna Stroke Study Group, J.-L. Mas, L. Cabanes, J. Coste, and the Patent Foramen Ovale and Atrial Septal Aneurys Patent Foramen Ovale, Atrial Septal Aneurysm, and Recurrent Stroke N. Engl. J. Med., April 25, 2002; 346(17): 1331 - 1332. [Full Text] [PDF]