title: Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients.
abstract: OBJECTIVE
  To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  University hospital (single institution).
  
  
  METHODS
  Patients presenting for cardiac surgery requiring TEE.
  
  
  METHODS
  Multiplane TEE including 2 atrial views with color-flow Doppler (CFD) and contrast echocardiography (CE) with a provocative respiratory maneuver (PRM) and comparison of multiplane TEE and VI with respect to PFO detection.
  
  
  RESULTS
  The cohort size was 187. PFO prevalence was 27.3%. CFD with serial decrease of the Nyquist limit detected 51% of all PFO: 41.2% in the bicaval view alone, 27.5% in the 4-chamber view alone, and 9.8% in both views. CE detected 78.4% of all PFO: 72.5% with PRM, 45.1% with no PRM, and 27.4% with/without PRM. PFO detection by multiplane TEE and visual inspection were correlated in 41 subjects. TEE diagnosed 11 PFO (26.8% prevalence, 3 missed by VI). VI diagnosed 12 PFO (29.3% prevalence, 4 missed by TEE).
  
  
  CONCLUSIONS
  Multiplane TEE is a gold standard for detection of PFO. Despite advances in TEE technology, 2-dimensional imaging does not detect all PFO. To maximize PFO detection, multiple TEE modalities are required in multiple views, despite a low Nyquist limit for CFD or a PRM for CE. Even though multiplane TEE is equivalent to VI for PFO detection, the discrepancy rate may be an important consideration in the individual case.
authors.affiliation: Cardiothoracic Section, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Weiss
authors.forename: Justin
authors.initials: J
authors.lastname: Weiner
authors.forename: Joshua
authors.initials: J
authors.lastname: Mancini
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Savino
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results