title: A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver.
abstract: Patent foramen ovale (PFO) is a remnant of the fetal circulation exist in 20% of the general population. The purpose of our study was to compare of transthoracic echocardiography (TTE) and contrast-transcranial Doppler sonography (c-TCD) in the diagnosis and quantification of PFO with or without the Valsalva maneuver (VM).We studied 106 patients with a high clinical suspicion for PFO prospectively. Simultaneous c-TCD and TTE were conducted using agitated saline solution to detect right to left shunt (RLS). To classify RLS, mainly PFO, we applied a 4-level visual classification for c-TCD test: no occurrence of micro-embolic signals; grade I, 1 to 10 signals; grade II, 10 to 30 signals but not curtain; and grade III, curtain pattern. We used the number of micro-bubbles appeared in left atrium per frame image to define classification for TTE test: no occurrence of micro-bubbles; grade I, 1 to 10 micro-bubbles; grade II, 10 to 30 micro-bubbles; and grade III, more than 30 micro-bubbles or left atrium nearly filled with micro-bubbles or left atrial opacity. Statistical analyses were performed using SPSS Version 18.0.RLS was detected in 36.0% in c-TCD test and in 46% in TTE test at rest (P = 0.158). And during the VM, RLS was detected in 99.0% in c-TCD test and in 83.0% in TTE test (P < 0.001). Compared with the positive results of c-TCD and TTE at rest, the positive results of them with VM is more higher, respectively (all P < 0.001). The VM obviously increased the number of micro-bubbles shunting.Both c-TCD and TTE should used as initial screening tool for PFO. VM increases the size of shunt. VM resulted in detection of more RLS both in c-TCD and TTE tests.
authors.affiliation: From the Department of Ultrasound, Second Affiliated Hospital of Medical School, Xi'an Jiao Tong University (EZ, YW, BL); Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University (YZ); and Transcranial Doppler Sonography Laboratory, Second Affiliated Hospital of Medical School, Xi'an Jiao Tong University, Xi'an, Shaanxi, China (NZ, PZ).
authors.forename: Enfa
authors.initials: E
authors.lastname: Zhao
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Wei
authors.forename: Yafei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Nina
authors.initials: N
authors.lastname: Zhai
authors.forename: Ping
authors.initials: P
authors.lastname: Zhao
authors.forename: Baomin
authors.initials: B
authors.lastname: Liu
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014636:Valsalva Maneuver