Transesophageal echocardiography for quantifying size of patent foramen ovale in patients with cryptogenic cerebrovascular events.
OBJECTIVE
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 (r(2)=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 (r(2)=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.
Schuchlenz
Herwig W
HW
Second Department of Medicine, Landeskrankenhaus-Universitätsklinikum Graz, Graz, Austria. herwig.schuchlenz@klinikum-graz.at
Weihs
Wolfgang
W
Beitzke
Albrecht
A
Stein
Jörg-Ingolf
JI
Gamillscheg
Andreas
A
Rehak
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D002545:Brain Ischemia / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal / Q000379:methods*; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging*
D003287:Contrast Media