Laboratorio de Ecocardiografía, Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona, España.
Rev Esp Cardiol. 2011 Feb;64(2):133-9. doi: 10.1016/j.recesp.2010.10.009.
Patent foramen ovale (PFO) is the most common cause of cryptogenic stroke in patients younger than 55. Transesophageal echocardiography (TEE) has been accepted as the reference diagnostic technique. The purpose of this study was to compare the accuracy of transthoracic echocardiography (TTE), TEE and transcranial Doppler (TCD) in the diagnosis and quantification of patent foramen ovale.
We studied 134 patients prospectively. Simultaneous TTE with TCD and TEE with TCD were performed, using agitated saline solution to detect right to left shunt.
In 93 patients diagnosed with PFO, the shunt was visualized at baseline by TCD in 69% of cases, by TTE in 74% and by TEE in 58%. The Valsalva maneuver produced a similar improvement in shunt diagnosis with all 3 techniques (26%-28%). TTE and TCD showed higher sensitivity (100% vs 97%; non significant difference) than TEE in the diagnosis of PFO (86%; P<.001). TCD performed during TEE did not diagnose 12 (13%) shunts previously diagnosed during TTE. Similarly, TEE underestimated shunt severity.
TTE enables adequate diagnosis and quantification of PFO. TEE is less sensitive and tends to underestimate the severity of the shunt.
卵圆孔未闭（PFO）是 55 岁以下患者隐源性卒中的最常见原因。经食管超声心动图（TEE）已被接受为参考诊断技术。本研究的目的是比较经胸超声心动图（TTE）、TEE 和经颅多普勒（TCD）在诊断和量化卵圆孔未闭中的准确性。
我们前瞻性研究了 134 例患者。同时进行 TTE 与 TCD 和 TEE 与 TCD，使用搅动盐水溶液检测右向左分流。
在 93 例诊断为 PFO 的患者中，TCD 在基线时观察到分流的比例为 69%，TTE 为 74%，TEE 为 58%。瓦尔萨尔瓦动作使所有 3 种技术的分流诊断均有类似的改善（26%-28%）。TTE 和 TCD 在诊断 PFO 方面的敏感性（100%与 97%；无显著性差异）均高于 TEE（86%；P<.001）。TEE 期间进行的 TCD 未能诊断 TTE 期间先前诊断的 12 个（13%）分流。同样，TEE 低估了分流的严重程度。
TTE 能够充分诊断和量化 PFO。TEE 的敏感性较低，且往往低估分流的严重程度。
