Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography

Cabanes, Laure; Coste, Joël; Dérumeaux, Geneviève; Jeanrenaud, Xavier; Lamy, Catherine; Zuber, Mathieu; Mas, Jean‐Louis

doi:10.1067/mje.2002.116718

Cited by 76 publications

(54 citation statements)

References 15 publications

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“…There was disagreement in the analysis of one large PFO and three small PFOs; however, they were all solved through consensus. This is in concordance with CABANES et al [25] who found considerable variation in small-PFO analysis with only a few bubbles passing to the left atrium. However, the clinical significance of these small shunts is probably very limited [5].…”

Section: Discussionsupporting

confidence: 81%

“…A PFO was defined as a minimum of three bubbles in the left atrium adjacent to the septum within three heartbeats from contrast filling of the right atrium [25]. The number of bubbles passing into the left atrium was estimated.…”

Section: Pfo Analysismentioning

confidence: 99%

“…All 2-mL injections were administered antecubitally while 10-mL injections were administered via the foot vein, followed by a bolus injection of 5-10 mL saline. Contrast injections were given according to a standardised protocol that included injections during relaxed breathing in the supine and left lateral cubitus position and multiple provocations such as the Valsalva manoeuvre, coughing and bed tilt [24,25]. In order to reduce preload, nitroglycerin (0.8 mg) was sprayed lingually during 10u foot-down bed tilt, and contrast was injected antecubitally during relaxed breathing and Valsalva.…”

Section: Transoesophageal Contrast Echocardiographymentioning

confidence: 99%

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The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

Johansson¹,

Eriksson²,

Peker³

et al. 2006

European Respiratory Journal

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Obstructive sleep apnoea (OSA) is associated with oxygen desaturation to a varying degree. A patent foramen ovale (PFO) may allow interatrial right-to-left shunting. The hypothesis of the current study was that oxygen desaturation will occur more often, in proportion to the frequency of respiratory disturbances, in OSA subjects with PFO than in those without.In a group of 209 subjects diagnosed with OSA, the proportion of desaturation to respiratory events was calculated as the ratio of oxygen desaturation index (ODI)/apnoea-hypopnoea index (AHI). A total of 15 cases with high proportional desaturation (ODI/AHI o0.66) were individually matched with 15 controls with low proportional desaturation (ODI/AHI f0.33), all without pulmonary disease. PFO was assessed with contrast transoesophageal echocardiography and considered large when o20 bubbles passed over from the right to the left atrium after a single injection.The prevalence of large PFO was nine out of 15 (60%) in the high proportional desaturation group versus two out of 15 (13%) in the low proportional desaturation group. The median number of passing bubbles was positively correlated to minimum oxygen saturation among those with PFO.In conclusion, oxygen desaturation occurs more often, in proportion to the frequency of respiratory disturbances, in obstructive sleep apnoea subjects with a patent foramen ovale than in those without.

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Section: Discussionsupporting

confidence: 81%

Section: Pfo Analysismentioning

confidence: 99%

Section: Transoesophageal Contrast Echocardiographymentioning

confidence: 99%

See 1 more Smart Citation

The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

Johansson¹,

Eriksson²,

Peker³

et al. 2006

European Respiratory Journal

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“…PFO was diagnosed when at least 3 microbubbles were identified in the left atrium within 3 cardiac cycles from the right atrium. 9 Atrial septal aneurysm was diagnosed when the atrial septum protruded into the left or right atrium or both for at least 15 mm. We observed all segments of the thoracic aorta, including the descending aorta, aortic arch, and ascending aorta, to detect aortic plaque.…”

Section: Tee Studymentioning

confidence: 99%

Right-to-left shunts may be not uncommon cause of TIA in Japan

Tateishi

Iguchi

Kimura

et al. 2009

Journal of the Neurological Sciences

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“…PFO diagnosis is done by using a contrast-enhanced technique (by injecting saline solution in a peripheral vein) while performing a transesophageal echocardiography (cTEE) and, when positive, it shows a high correlation with necropsy studies 7 . In spite of both high sensibility and specificity, cTEE have some limitations, such as expensiveness, patient's low tolerability and imperfect intra and inter-observer correlation, due to the fact that it is an operator-dependent method 8 . A great ad-vantage of this method is the direct visualization of interatrial septum and atrial septal aneurysm (ASA) identification.…”

mentioning

confidence: 99%

Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

Lange

Zétola

Souza

et al. 2008

Arq. Neuro-Psiquiatr.

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-Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. Aim: To evaluate cTCD for PFO screening comparing it to cTEE. Method: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. Results: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. Conclusion: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.KEy wORDS: patent foramen ovale, transesophageal echocardiography, transcranial Doppler, ultrasonography. Doppler transcraniano contrastado para triagem de forame oval patente: existe boa correlação com ecocardiograma transesofágico?Resumo -A comunicação direita-esquerda (CDE) pode ser identificada por Doppler transcraniano contrastado (DTCc) em pacientes com forame oval patente (FOP Patent foramen ovale (PFO) is a congenital heart disease characterized by an opening between the right and left atria resulting from incomplete closure of the ostium secundum by the septum secundum 1 . Recent studies have found an increase prevalence of PFO in women with migraine with aura and young adults (less than 55 years old) with so-called "cryptogenic" ischemic stroke [2][3][4][5][6] . Emboli from the venous system can cross the PFO reaching the arterial circulation through a right-to-left shunt (RLS) and thus leading to a stroke. PFO diagnosis is done by using a contrast-enhanced technique (by injecting saline solution in a peripheral vein) while performing a transesophageal echocardiography (cTEE) and, when positive, it shows a high correlation with necropsy studies 7 . In spite of both high sensibility and specificity, cTEE have some limitations, such as expensiveness, patient's low tolerability and imperfect intra and inter-observer correlation, due to the fact that it is an operator-dependent method 8 . A great ad-

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Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography

Cited by 76 publications

References 15 publications

The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

Right-to-left shunts may be not uncommon cause of TIA in Japan

Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

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