Author + information
- Miriam Shanks, MD⁎,
- Dulka Manawadu, MD†,
- Isabelle Vonder Muhll, MD⁎,
- Khurshid Khan, MD‡,
- Harald Becher, MD, PhD⁎ and
- Jonathan Choy, MD⁎,⁎ ()
- ↵⁎Address for Correspondence:
Dr. Jonathan Choy, Division of Cardiology, University of Alberta Hospital, 8440-112 Street, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2B7, Canada
TECHNICAL ADVANCES IN PATENT FORAMEN OVALE (PFO) DEVICE CLOSURE RESULTED IN GREATER CLINICAL IMPORTANCE TO OPTIMALLY DIAGNOSE INTRACARDIAC SHUNTS. Two-dimensional transesophageal echocardiography (2DTEE) with agitated saline contrast is currently the gold standard for diagnosing PFO. However, direct visualization of the bubbles crossing PFO through a septal separation is often difficult to capture by 2DTEE in a single imaging plane. Conventional 3-beat rule of bubble appearance in the left atrium after a complete right atrial opacification to differentiate PFOs from extracardiac shunts is unreliable. Valsalva maneuver often used to improve the detection of PFOs may be difficult to perform in the sedated patients during TEE. The advent of a real-time 3-dimensional transesophageal echocardiography (3DTEE) allowed direct visualization of the entire fossa ovalis and surrounding structures. It may potentially result in more accurate diagnosis of PFO by directly visualizing the bubbles crossing fossa ovalis.
We present images (Figs. 1, 2, 3, and 4)⇓⇓⇓ obtained from patients with cryptogenic stroke referred for routine 2DTEE to rule out cardiac sources of embolism. Agitated saline contrast was performed during 2DTEE and 3DTEE. High quality of 3-dimensional images suggested that 3DTEE is feasible. Unlike 2DTEE, 3DTEE provided detailed description of the entire PFO anatomy and surrounding structures and potentially higher degree of certainty in differentiating intracardiac from extracardiac shunts.
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Dr. Shanks has received a research grant from University Hospital Foundation and speakers honorarium from the Canadian Society of Cardiology. Dr. Becher has received research grants from Heart and Stroke Foundation of Alberta, Philips, Lantheus, and Toshiba; has consulted for Bracco and Acusphere; and is on the Speakers' Bureau for Bracco. Dr. Choy has received research grants and honoraria from Philips and Lantheus Medical Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation