Belkin R N, Pollack B D, Ruggiero M L, Alas L L, Tatini U
Division of Cardiology, Westchester County Medical Center, Valhalla, NY 10595.
Am Heart J. 1994 Sep;128(3):520-5. doi: 10.1016/0002-8703(94)90626-2.
We directly compared the utility of agitated saline solution contrast echocardiography and color flow Doppler with both transthoracic and transesophageal echocardiography in the detection of patient foramen ovale (PFO). Forty-three patients referred for contrast echocardiography and transesophageal echocardiography were prospectively studied. Three were excluded because of technically inadequate contrast, and two were excluded because of hemodynamically significant atrial septal defect. The remaining 38 patients, who ranged in age from 19 to 73 years, were referred for cerebrovascular events (31), peripheral embolus (5), atrial septal aneurysm (1), and suspected atrial septal defect (1). With either contrast or color flow Doppler, PFO was detected by transthoracic imaging in 9 (24%) of 38 patients compared with 20 (53%) of 38 with transesophageal echo. PFO was present in 1 (3%) of 38 by TTE color flow, 9 (24%) of 38 by TTE contrast, 17 (45%) of 38 by TEE color flow, and 14 (37%) of 38 by TEE contrast. Discordant findings with TEE were the result of contrast-positive, color-negative results in 3 patients and color-positive, contrast-negative results in 6. With TEE contrast used as a diagnostic gold standard, other techniques detected PFO with the following sensitivities, specificities, and positive and negative predictive values: TEE color flow 79%, 75%, 65%, 86%, respectively; TTE contrast 50%, 92%, 78%, 76%, respectively; and TTE color flow 7%, 100%, 50%, 65%, respectively. Thus PFO is detected more frequently with TEE. TEE contrast and color flow Doppler yielded discordant findings in a minority of patients, probably as a result of intrinsic limitations in each technique.(ABSTRACT TRUNCATED AT 250 WORDS)
我们直接比较了搅拌生理盐水对比超声心动图和彩色多普勒血流成像与经胸和经食管超声心动图在检测患者卵圆孔未闭（PFO）方面的效用。对43例因对比超声心动图和经食管超声心动图检查而转诊的患者进行了前瞻性研究。3例因对比技术不充分被排除，2例因血流动力学显著的房间隔缺损被排除。其余38例患者，年龄在19至73岁之间，因脑血管事件（31例）、外周栓子（5例）、房间隔瘤（1例）和疑似房间隔缺损（1例）而转诊。使用对比剂或彩色多普勒血流成像时，经胸成像检测到38例患者中有9例（24%）存在PFO，经食管超声心动图检测到38例患者中有20例（53%）存在PFO。经胸彩色多普勒血流成像检测到38例中有1例（3%）存在PFO，经胸对比剂检测到38例中有9例（24%）存在PFO，经食管彩色多普勒血流成像检测到38例中有17例（45%）存在PFO，经食管对比剂检测到38例中有14例（37%）存在PFO。经食管超声心动图的不一致结果是由于3例患者出现对比剂阳性、彩色血流阴性结果，6例患者出现彩色血流阳性、对比剂阴性结果。以经食管超声心动图对比剂作为诊断金标准，其他技术检测PFO的敏感性、特异性、阳性预测值和阴性预测值如下：经食管彩色多普勒血流成像分别为79%、75%、65%、86%；经胸对比剂分别为50%、92%、78%、76%；经胸彩色多普勒血流成像分别为7%、100%、50%、65%。因此，经食管超声心动图更常检测到PFO。经食管超声心动图对比剂和彩色多普勒血流成像在少数患者中产生了不一致的结果，这可能是由于每种技术本身的局限性所致。（摘要截断于250字）
