Yamashita Eiji, Murata Tomoyuki, Goto Eri, Fujiwara Takeshi, Sasaki Takehito, Minami Kentaro, Nakamura Kohki, Kumagai Koji, Naito Shigeto, Kario Kazuomi, Oshima Shigeru
Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
J Am Soc Echocardiogr. 2017 Mar;30(3):292-299. doi: 10.1016/j.echo.2016.11.011. Epub 2016 Dec 23.
The Valsalva maneuver, the most sensitive test for patent foramen ovale (PFO) detection, is difficult during transesophageal echocardiography (TEE), especially after sedation. The aim of this study was to compare PFO detection effectiveness between inferior vena cava (IVC) compression and the Valsalva maneuver.
A total of 293 patients with paroxysmal atrial fibrillation undergoing TEE before initial atrial fibrillation ablation were prospectively enrolled. Agitated saline was injected in 290 patients under three conditions: Valsalva maneuver under conscious sedation, at rest, and IVC compression under deep sedation. Three patients with newly diagnosed atrial septal defects on TEE were excluded. The IVC compression maneuver consisted of manual compression 5 cm to the right of the epigastric region and depressed the abdominal wall by 5 cm for 30 sec and compression release immediately before right atrial opacification with microbubbles by agitated intravenous saline.
The overall PFO detection rate was better with IVC compression (57 PFOs [19.7%]) than at rest (15 patients [5.2%]) (P < .0001) or with the Valsalva maneuver (37 patients [12.8%]) (P = .024). There were no significant differences in PFO detection between IVC compression and the Valsalva maneuver (IVC compression, 43 patients [22.5%]; Valsalva maneuver, 35 patients [18.3%]; P = .31), even in patients who could perform the Valsalva maneuver effectively (n = 191).
IVC compression is feasible and effective for detecting PFO and is not inferior to the Valsalva maneuver. In particular, IVC compression could be an alternative diagnostic method for PFO using TEE when the Valsalva maneuver cannot be performed under deep sedation.
瓦氏动作是检测卵圆孔未闭（PFO）最敏感的试验，但在经食管超声心动图（TEE）检查期间实施困难，尤其是在镇静后。本研究旨在比较下腔静脉（IVC）压迫与瓦氏动作在检测PFO方面的有效性。
前瞻性纳入293例在初次房颤消融术前接受TEE检查的阵发性房颤患者。290例患者在三种情况下注射振摇生理盐水：清醒镇静下的瓦氏动作、静息状态以及深度镇静下的IVC压迫。3例TEE新诊断为房间隔缺损的患者被排除。IVC压迫动作包括在剑突右侧5 cm处手动压迫并将腹壁下压5 cm持续30秒，并在通过静脉注射振摇生理盐水使微泡使右心房显影前立即解除压迫。
IVC压迫时的总体PFO检出率（57例PFO [19.7%]）高于静息状态（15例患者 [5.2%]）（P <.0001）或瓦氏动作时（37例患者 [12.8%]）（P =.024）。IVC压迫与瓦氏动作在PFO检测方面无显著差异（IVC压迫，43例患者 [22.5%]；瓦氏动作，35例患者 [18.3%]；P =.31），即使在能够有效完成瓦氏动作的患者中（n = 191）也是如此。
IVC压迫检测PFO可行且有效，并不逊色于瓦氏动作。特别是，当在深度镇静下无法进行瓦氏动作时，IVC压迫可能是一种使用TEE诊断PFO的替代方法。
