Diagnosing a patent foramen ovale in children: is transesophageal echocardiography necessary?
OBJECTIVE
transesophageal echocardiography (TEE) is the gold standard for the diagnosis of a patent foramen ovale in adults. In children, acoustic windows on transthoracic echocardiography (TTE) are better than in adults; thus, an invasive TEE may not be necessary. Our goal was to assess the validity of TTE with agitated saline injection for the diagnosis of a patent foramen ovale in children using TEE as the gold standard.


METHODS
fifty consecutive pediatric patients >1 year of age referred for TEE were prospectively enrolled. Imaging included 2-dimensional, color Doppler, and agitated saline contrast injections with and without Valsalva by TTE followed by TEE. Interpreters of the TTE were blinded to TEE results. Studies were categorized as "inconclusive" if the TTE images were inadequate for definitive diagnosis by the blinded interpreter.


RESULTS
TTE results were considered conclusive in 43 of 50 (86%) patients. Among the 43 conclusive studies, the 2 modalities disagreed in 1 patient. TTE had a positive predictive value of 100%, negative predictive value 97%, sensitivity of 88%, and specificity of 100% for detecting a patent foramen ovale.


CONCLUSIONS
TTE with agitated saline injection is diagnostic for the assessment of atrial septal integrity in the majority of children.
CMC Cardiology, 1935 Medical District Drive, Dallas, TX 75235. catherine.ikemba@childrens.com.
Zakariya
Z
Hubail
Matthew
M
Lemler
Claudio
C
Ramaciotti
Jay
J
Moore
Catherine
C
Ikemba
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D054085:Foramen Ovale / Q000000981:diagnostic imaging*; D054092:Foramen Ovale, Patent / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity