| Objective:To compare the diagnostic value of patent foramen ovale(PFO)by contrast transthoracic echocardiography(cTTE)and transesophageal echocardiography(TEE)in patients and provide basis for clinical treatment.Methods:354 patients with a high clinical suspicion for PFO had transthoracic echocardiography(TTE)and cTTE performed from January 2017 to September 2020 were analyzed retrospectively.Among them,147 patients underwent transesophageal echocardiography(TEE)examination.A total of 74 cases of transcatheter PFO closure were performed.69 cases underwent cTTE examination after transcatheter PFO closure.Collect and analyze basic clinical data,including gender,age,stroke,transient ischemic attack,coronary heart disease,arrhythmia,and other diseases(including heart disease,narcolepsy,unexplained epilepsy,facial neuritis,or accidental PFO,etc.);auxiliary examination data include transthoracic echocardiography atrial septum two-dimensional and color Doppler echo,right-to-left sonocontrast shunt degree and transesophageal echocardiography to check the length,width,shunt direction and accompanying Some atrial septal anoma and inferior vena cava valve;a history of PFO interventional closure surgery,and postoperative contrast transthoracic echocardiography to detect the degree of residual right to left shunt.Results:Among the 354 clinically suspected patients with patent foramen ovale,there were140 cases of stroke,40 cases of transient ischemic attack,24 cases of headache,65 cases of coronary heart disease,16 cases of arrhythmia,and 69 cases of other cases.In this group of subjects,74 patients underwent percutaneous patent foramen ovale interventional closure,including 29 strokes,21 transient ischemic attacks,8 headaches,5 coronary heart diseases,and 1 arrhythmia.10 other cases.There was statistically significant difference in the degree of right to left shunt between patients with patent foramen ovale positive for surgery and patients without surgery for patent foramen ovale positive(P < 0.05).CTTE was performed after PFO closure by percutaneous intervention,and the right to left shunt was assessed respectively.A total of 69 people were examined one week after the operation,and the positive detection rate was 46.3%(32/69).Three months after the operation,24 cases were checked,and 8 were positive.One year after the operation,6 were checked,and2 were positive.One of them was consistent with the preoperative shunt level.There was a statistically significant difference in the detection rate of cTTE for PFO was 93.2%(97/104)and TTE was 72.1%(75/104)(P<0.05).The average width of PFO detected by TEE was(1.7±0.8)mm.There were 48 cases with length ≥8mm,104 cases with left to right shunt,42 cases of atrial septal aneurysm were detected,of which 33 cases were combined with PFO,and 5 cases with inferior vena cava valve.It was found that in 16 patients with positive cTTE presence of right to left shunts,there weren’t obvious abnormalities in the atrial septum in TTE and TEE,10 cases were grade 1,3 cases were grade 2,3 cases were right to left Patients with shunt grade 3 were treated with patent foramen ovale occlusion.Conclusions:1.Contrast transthoracic echocardiography has important clinical application value in the screening of patients before the closure of patent foramen ovale and the evaluation of the curative effect after closure.2.TEE can intuitively,clearly and accurately assess the atrial septal structure,judge whether the atrial level has left to right shunt.3.The combined use of right-heart contrast echocardiography and transesophageal echocardiography is beneficial to increase the detection rate of patent foramen ovale,and is of great significance to the evaluation of the patient’s condition and the choice of treatment options. |
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