Chen Lixin, Sheng Yuanyuan, Huang Yuxiang, Li Jian, Liu Xiaohua, Liu Qian, Shi Bobo, Zhong Xiaofang, Xu Jinfeng, Liu Yingying
Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China.
Diagnostics (Basel). 2022 Apr 13;12(4):980. doi: 10.3390/diagnostics12040980.
The Valsalva maneuver (VM) is the most sensitive auxiliary method for the detection of patent foramen ovale (PFO), but it is difficult to assess whether the maneuver is adequately performed during transesophageal echocardiography (TEE). In this study, we tried to use aortic root downward movement as a novel method for judging whether VM was adequate or not, and to evaluate whether this novel method can increase the sensitivity of detecting PFO. A total of 224 patients with clinically suspected PFO were enrolled in this study. These patients were injected with activated normal saline to detect the right-to-left shunt (RLS), in the following three conditions: contrast-enhanced transthoracic echocardiography under adequate VM (AVM cTTE), contrast-enhanced TEE under non-adequate VM (non-AVM cTEE), and cTEE under adequate VM (AVM cTEE). A novel method in which the aorta root moves downward (movement range ≥16 mm) in the cTEE judged whether AVM was performed. The PFO detection rate and sensitivity of AVM cTEE were better than that of non-AVM cTEE (detection rate: 108 PFOs [48.2%] vs. 86 PFOs [38.4%], p = 0.036; sensitivity: 100% vs. 79.6%). Among AVM cTTE, non-AVM cTEE, and AVM cTEE, the RLS grade evaluation results were inconsistent, with significant differences (p < 0.05). Non-AVM cTEE had RLS underestimation or false negatives. Compared with non-AVM cTEE, AVM cTEE and AVM cTTE had better consistency in evaluating PFO RLS (kappa value = 0.675). Aortic root downward movement could be used as a novel method for judging the effectiveness of VM, which is critical for the detection of PFO in cTEE. Concerning effectiveness and convenience, this method should be promoted during the clinical detection of PFO.
瓦尔萨尔瓦动作（VM）是检测卵圆孔未闭（PFO）最敏感的辅助方法，但在经食管超声心动图（TEE）检查过程中，很难评估该动作是否执行得当。在本研究中，我们尝试将主动脉根部向下移动作为判断VM是否得当的新方法，并评估这种新方法能否提高检测PFO的敏感性。本研究共纳入224例临床疑似PFO的患者。这些患者在以下三种情况下注射激活的生理盐水以检测右向左分流（RLS）：VM充分时的对比增强经胸超声心动图（AVM cTTE）、VM不充分时的对比增强TEE（非AVM cTEE）以及VM充分时的cTEE（AVM cTEE）。在cTEE中，一种通过主动脉根部向下移动（移动范围≥16 mm）来判断是否执行了AVM的新方法。AVM cTEE的PFO检测率和敏感性优于非AVM cTEE（检测率：108例PFO [48.2%] 对86例PFO [38.4%]，p = 0.036；敏感性：100%对79.6%）。在AVM cTTE、非AVM cTEE和AVM cTEE中，RLS分级评估结果不一致，差异有统计学意义（p < 0.05）。非AVM cTEE存在RLS低估或假阴性。与非AVM cTEE相比，AVM cTEE和AVM cTTE在评估PFO RLS方面具有更好的一致性（kappa值 = 0.675）。主动脉根部向下移动可作为判断VM有效性的新方法，这对cTEE中PFO的检测至关重要。考虑到有效性和便利性，该方法在PFO的临床检测中应予以推广。
