Contrast transesophageal echocardiography using the Acunav ultrasound catheter through the mouth way as a guide to percutaneous closure of patent foramen ovale.
OBJECTIVE
Contrast-enhanced transesophageal echo-cardiography (c-TEE) represents the gold standard in the diagnosis of patent foramen ovale (PFO) but it is not always well tolerated by the patient, and it is influenced by his cooperation. Purpose of the present study was to assess feasibility and safety of c-TEE through the oral way using a miniaturized 10-Fr, monoplane probe (Acunav-TEE) and establish its utility in the diagnosis or PFO when compared with c-TEE using the traditional multiplane probe (standard-TEE).


METHODS
From January 2008 to September 2008, 54 consecutive patients with presumed paradoxical cerebrovascular events and a suspected PFO were prospectively enrolled in this study. After signing a consensus form, these patients underwent both standard-TEE and Acunav-TEE in the same day by two independent operators.


RESULTS
Feasibility of standard-TEE in our study was 96.3% (52/54) while feasibility of Acunav-TEE was 100% (54/54). When compared to standard-TEE, Acunav-TEE required shorter average time to insert the probe (1.0+/-0.2 vs. 4.1+/-1.1 minutes, P<0.001) but longer average time to look for the best projection and start the examination (13.8+/-2.4 vs. 9.1+/-2.7 minutes, P<0.001). Using standard-TEE as gold standard we defined a sensitivity of 100% (20/20) and a specificity of 97% (31/32) for Acunav-TEE. The positive predictive value, the negative predictive value and the global diagnostic accuracy were 95% (20/21), 100% (31/31) and 98% (51/52), respectively.


CONCLUSIONS
Consistent with our experience, Acunav-TEE seems to be a feasible and safe technique when used for the diagnosis of PFO, with excellent sensitivity and specificity as compared with standard-TEE.
Mangiafico
S
S
Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
Scandura
S
S
Capodanno
D
D
Arcidiacono
A A
AA
Santonoceto
L
L
Cilia
G
G
Ussiac Tamburino
G P
GP
D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D009055:Mouth; D011446:Prospective Studies
D003287:Contrast Media