Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up

Abstract

Patent foramen ovale (PFO) is present in 15%À30% of the general population and has been associated with various pathologic states, including cryptogenic stroke, platypneaÀorthodeoxia syndrome, decompression sickness and migraine with auras. Transesophageal echocardiography (TEE) has a major role in the diagnostic evaluation of PFO, as well as in the post-procedural assessment after transcatheter closure. The goals of this article were to synthesize the echocardiographic transesophageal techniques required for accurate PFO diagnosis and careful anatomic assessment of its anatomic variants, to focus TEE indications for device closure as complementary to clinical indications and to assess the role of TEE in the post-procedure follow-up.

Pulmonary arteriovenous fistula diagnosed by transthoracic contrast echocardiography: A case report

“…Therefore, the key to treatment is the detection of RLS. Contrast echocardiography has important diagnostic value 4‐6 . Contrast transthoracic echocardiography is simple and safe.…”

Intelligent Prediction of Cryptogenic Stroke Using Patent Foramen Ovale from TEE Imaging Data and Machine Learning Methods

“…However, both sets of studies have ignored the fact that PFO shape, interatrial hemodynamics, and atrial pressures change with the cardiac cycle. Regardless of physiological condition, each normal cardiac cycle during right ventricular early diastole and isovolumetric contraction presents a transient spontaneous reversal of left and right atrial pressures [7], and this reversal gradient may increase substantially with certain physiological conditions, such as a cough, inspiration, and Valsalva maneuver. Transcatheter PFO closure has been suggested as one therapeutic option of CS; while no strong data from randomized clinical trials have been provided to support primary preventive PFO closure, many results have pointed to the benefits of preventative PFO closure in certain highrisk patients [8].…”

Integrating measurements of pulmonary gas exchange to answer clinically relevant questions

“…Absence of pulmonary hypertension at rest did not preclude right-to-left shunt (putative mechanisms in the study by Vitarelli). (2) The rate of alveolar gas exchange can be substantially impaired despite preserved lung parenchyma. If hypoxemia cannot be explained by hypoventilation-high PaCO 2 and alveolar partial pressure of CO 2 (P A CO 2 ), leading to low alveolar partial pressure of O 2 (P A O 2 )-or low inspired O 2 pressure (e.g., high altitude), impaired pulmonary perfusion should be considered as the most likely explanation.…”

“…Absence of pulmonary hypertension at rest did not preclude right-to-left shunt (putative mechanisms in the study by Vitarelli). 2 …”