Pitfalls in diagnosing PFO: characteristics of false-negative contrast injections during transesophageal echocardiography in patients with patent foramen ovales.
BACKGROUND
Contrast injections during transesophageal echocardiography for patent foramen ovale (PFO) detection may be false negative. The characteristics of false-negative injections were studied retrospectively.


METHODS
Contrast transesophageal echocardiography was analyzed for the presence or absence of two characteristics: leftward bulging of the interatrial septum and dense contrast filling of the region of the right atrium adjacent to the interatrial septum.


RESULTS
Two hundred forty-seven injections were administered to 14 patients with PFOs, and 130 (53%) were false negative. The absence of either characteristic during a single injection resulted in low sensitivity for PFO detection of 7%. When the two characteristics were present at the same time, the sensitivity for PFO detection after a single injection was as high as 95%.


CONCLUSIONS
The simultaneous presence of both leftward bulging of the interatrial septum and dense contrast filling of the region in the right atrium, adjacent to the interatrial septum, is a prerequisite for PFO detection, and if either characteristic is missing, the injection is inconclusive.
Johansson
Magnus C
MC
Department of Emergency and Cardiovascular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. magnus.c.johansson@vgregion.se
Eriksson
Peter
P
Guron
Cecilia Wallentin
CW
Dellborg
Mikael
M
D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011097:Polygeline; D012016:Reference Values; D012720:Severity of Illness Index
D003287:Contrast Media; D011097:Polygeline