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.

Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review

“…1 Agitated saline delivered via the antecubital vein may stream directly along this valve into the right ventricle, resulting in incomplete opacification of the right atrium and a false-negative result. 93,94 In contrast, AS delivered via the femoral vein is preferentially directed towards the atrial septum in patients with a persistent eustachian valve. 94 Chronically elevated left heart pressures predispose to a false-negative bubble result.…”

Reply to Dr. Rajendram’s Letter to Editor: “Point of Care Ultrasound During the Covid-19 Pandemic Should Screen for Inter-Atrial Shunt”

“…Right heart contrast echocardiography (RHCE) is an established technique, which is mainly used to diagnose patent foramen ovale (PFO) and abnormal intrapulmonary circulation [4][5][6][7]. It is widely used to screen patients with suspected retro-embolization.…”

Early Diagnosis of Cardiovascular Diseases in Workers: Role of Standard and Advanced Echocardiography

“…Transesophageal echocardiography (TEE) has become an established approach ( Figure 6 ) to guide the interventional treatment of interatrial shunts [ 93 – 97 ]. Contrast transthoracic echocardiography (TTE) has a role as a screening tool in patients with unclear right volume overload or after systemic embolic events [ 98 ] but is not capable of differentiating between PFO and the various kinds of ASDs and not suitable for guiding percutaneous device closure of interatrial communications.…”