title: When to use femoral vein injection for diagnosis of patent foramen ovale-Effect of a persistent eustachian valve on right atrial flow patterns during contrast transesophageal echocardiography.
abstract: Contrast echocardiography using agitated saline injected into the antecubital vein is the most common method used for the diagnosis of patent foramen ovale. We describe a case whereby the presence of a persistent eustachian valve and a "negative contrast sign" during contrast transesophageal echocardiography raised suspicion of a false-negative result. Femoral vein injection of contrast successfully demonstrated a patent foramen ovale. Femoral vein injection should be considered if this scenario is recognized because the eustachian valve directs blood preferentially from the inferior vena cava toward the interatrial septum and this route may prove to be more reliable.
authors.affiliation: Department of Cardiology, Barts Heart Centre, London, United Kingdom.
authors.forename: Tat W
authors.identifier: http://orcid.org/0000-0003-3299-2318
authors.initials: TW
authors.lastname: Koh
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005188:False Negative Reactions; D005268:Femoral Vein; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: contrast imaging; contrast microbubbles; eustachian valve; patent foramen ovale; transesophageal echocardiography