The Comparison Of Diagnosis Of Patent Foramen Ovale Using Contrast Transcranial Doppler、Transesophageal Echocardiography And Transthsoracic Echocardiography

Background and purpose：Patent foramen ovale(PFO) is the most common congenitalHeart disease,and it is related to cryptogenic Stroke、migraine with Aura、decompressionsickness、 obstructive Sleep Apnea.Transesophageal echocardiography(TEE) has beenaccepted as the reference diagnostic technique.Recent studies have suggested that ContrastTranscranial Doppler(c-TCD) has a high sensitivity of detecting patent foramen ovale,andprobably higher than Transthroracic Echocardiography(TTE) and TEE.This study aims tocompare the accuracy of c-TCD、TTE and TEE in the diagnosis of PFO.Object and Methods: We studied3554patients(2010-2012). All underwent c-TCD todetect PFO,at rest and Valsalva Manoeuvre(VM).Of these some patients undervent TTE andTEE.The result at rest and VM was compared.The accuracy of TTE and TEE was calculatedby comparing them with c-TCD. A four-level categorization based on the microbubble countwas applied to evaluate the severity of the shunt.The positive rate of TTE of different gradewere compared，and the positive rate of TEE of different grade were compared,too.Thepositive rate of TTE and TEE of the same grade were compared with each other.Results: A total of3554patients underwent c-TCD (mean age36.64years,SD13.46,67.6%female).Of these955patients underwent TTE,40patients underwent TEE.The positiverate of PFO was higher at VM than at rest(34.95%>20.77%，P<0.005).PFO detection washigher with c-TCD than TTE(62.73%>49.95%,P<0.005).PFO detection was higher withc-TCD than TEE(97.5%>85.0%,P>0.05).The TTE compared with c-TCD showed:sensitivity75.96%,specificity93.82%,positive predict value(PPV)95.39%,negative predictvalue(NPV)69.87%and accuracy82.62%.The TEE compared with c-TCD showed:sensitivity87.18%,specificity100%,PPV100%,NPV16.67%and accuracy87.5%.The TTEpositive rate of different grade was continuous increase (57.01%<92.45%<94.85%, P<0.005).The TEE positive rate of different grade was the same continuous increase (81.82%<87.5%<90%,P>0.05). The positive rate of TEE of grade I was higher than thepositive rate of TTE(X2=2.68，P>0.05). The positive rate of TEE of grade II was lower thanthe positive rate of TTE(X2=0.26，P>0.05).The positive rate of TEE of grade III was lowerthan the positive rate of TTE(X2=0.76，P>0.05)。Conclusions： The sensitivity of TTE and TEE compared withc-TCD,c-TCD=TEE;c-TCD>TTE. In clinical studies, highly suspected patients with PFOshould undergo c-TCD as the first technique of PFO detection,the positive one can diagnosePFO.The patients whose result is positive can undergo TEE atanomically. TTE can only detectlarge PFO well.