title: Transesophageal echocardiography for quantifying size of patent foramen ovale in patients with cryptogenic cerebrovascular events.
abstract: 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.
authors.affiliation: Second Department of Medicine, Landeskrankenhaus-Universitätsklinikum Graz, Graz, Austria. herwig.schuchlenz@klinikum-graz.at
authors.forename: Herwig W
authors.initials: HW
authors.lastname: Schuchlenz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weihs
authors.forename: Albrecht
authors.initials: A
authors.lastname: Beitzke
authors.forename: Jörg-Ingolf
authors.initials: JI
authors.lastname: Stein
authors.forename: Andreas
authors.initials: A
authors.lastname: Gamillscheg
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
mesh_terms: 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*
chemical_list: D003287:Contrast Media