Comparative Study Of Several Diagnostic Methods For Patent Foramen Ovale

Objective:Patent foramen ovale(PFO)is one of the most common congenital cardiac abnormalities in adults.The commonly used methods for clinical diagnosis of patent foramen ovale include Transcranial Doppler saline contrast test(c-TCD).Transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)and their saline contrast test(c-TTE,c-TEE).However,there are some false positive and false negative rates in these tests.Therefore,the main purpose of this study is to compare and observe the diagnostic value of different methods in the diagnosis of patent foramen ovale.Method:Selection in from January 2017 to March 2018 in Shandong University Qilu Hospital for intervention closure treatment of 90 patients with made as the research object,all the patients were given c-TCD,TTE,c-TTE,TEE andc-TEE examination,three check saline contrast test respectively in resting with Valsalva action under two conditions.In transcatheter interventional closure procedure,if the right cardiac catheter can pass through patent foramen reach the left atrium from the right atrium or contrast agent can reach the left atrium by patent foramen as the gold standard for presence of patent foramen ovale.Three kinds of saline contrast test based on micro bubble number left heart chamber is divided into four levels:negative,small,medium and large.The results of c-TCD,c-TTE and color blood flow,TEE and color blood flow,and c-TCD,c-TTE andc-TEE were compared and observed in the condition of resting and Valsalva movement.Computing the sensitivity of various inspection methods,specific degrees,false negative rate and false positive rate and positive predictive value,negative predictive value,according to the results of the data analysis of various inspection methods for diagnosing the value of a patent foramen ovaleResult:(1)All 90 cases were treated with transcatheter intervention,86 cases were proved to be PFO,4 without PFO,1 case was pulmonary arteriovenous fistula,the incidence of PFO was 95.56%.(2)In 86 patients with PFO,the positive rate of c-TCD at rest was 69.77%,and the positive rate of c-TCD under Valsalva was 89.53%.There was significant difference between the two groups(P<0.05).(3)In PFO,9 patients were c-TCD negative,4 were positive,16 were large,9 were c-TTE negative,9 were positive,12 were moderate,56 were large,19 had middle echo and 67 had no echo interruption.There were 18 cases of blood flow in TTE,68 cases of no blood flow,10 cases of negative c-TEE,8 cases of positive small amount,10 cases of middle dose,58 cases of large number,71 cases of fissure and 21 cases of blood flow.(4)The sensitivity of each index to diagnose PFO:The sensitivity of total c-TCD is 89.53%,the sensitivity of only a large number is 86.36%,and the comprehensive sensitivity of a large number+medium is 89.02%.The diagnostic sensitivity of TTE with echo interruption was 22.09%.The diagnostic sensitivity of TTE with color blood flow was 20.93%.The sensitivity of the total c-TTE was 89.53%,that of a large number of samples was 86.15%,and that of a large number of samples+medium was 88.31%.The sensitivity of TEE with fissure was 82.56%,and the sensitivity of TEE with color blood flow was 24.42%.The sensitivity of total c-TEE was 88.37%,the sensitivity of mass only was 85.29%,and the comprehensive sensitivity of mass+median was 87.18%.(5)Specificity,false positive rate and negative predictive value of PFO diagnosis of each index:due to the small number of patients without PFO,the calculated results deviated from the clinical practice greatly,and accurate comparison results could not be made,Therefore,no comparative analysis was performed for specificity,false positive rate and negative predictive value in this experiment.(6)False negative rate:the comprehensive false negative rate of c-TCD was 10.47%,the small amount was 69.23%,the medium amount was 36%,the large amount was 13.64%,and the large+medium amount was 10.98%The false negative rate was 77.91%for TTE without echo interruption,79.07%for TTE without color blood flow,10.47%for total c-TTE,50%for small amount,42.86%for medium amount,13.85%for large amount,and 11.69%for large+medium amountThe false negative rate of TEE without fissure was 17.44%,and the false negative rate of TEE without blood flow was 7.58%.The false negative rate of total c-TEE was 11.63%,small amount was 50%,medium amount was 42.86%,large amount was 14.71%,large amount+medium was 12.82%.(7)Positive predictive value:The positive predictive value of c-TCD was 95.06%.The positive predictive value of a large number of samples was 98.28%.The comprehensive positive predictive value of large+medium is 96.05%.The positive predictive value of TTE with echo interruption was 95%,and the positive predictive value of TTE with color blood flow was 100%.The comprehensive positive predictive value of c-TTE was 96.20%,the positive predictive value of large amount was 98.24%,and the positive predictive value of large amount+medium was 95.77%.The positive predictive value of TEE two-dimensional with fissure was 95.95%,the positive predictive value of TEE with blood flow was 100%,and the comprehensive positive predictive value of c-TEE was 95%.The positive predictive value of large amount was 98.30%,and the comprehensive positive predictive value of large amount+ median was 95.77%Conclusion:In the process of PFO diagnosis,there are many ultrasonic diagnostic technologies to choose,TTE is one of the commonly used detection methods,but due to its vulnerability to image quality and other factors,the inspection results are not reliable enough.c-TTE has obvious advantages in diagnosis of PFO,and its sensitivity is significantly higher than that of TTE,so it can be widely used in clinical diagnosis.TEE is the most standard detection method,and it is also the currently recognized gold standard for diagnosing patent foramen ovale.With the popularization of clinical diagnostic technology and PFO interventional closure,it is found in clinical practice that TEE also has misdiagnosis rate in diagnosis of PFO.The role of c-TCD in diagnosis of PFO has been paid more and more attention by clinicians.At present,c-TCD is widely used in the practical operation of diagnosis of PFO,and its advantages are more and more prominent.In this study,it was found by comparative observation that c-TCD,c-TTE,TEE two-dimensional ultrasound andc-TEE had higher sensitivity,while c-TCD andc-TEE were simpler than TEE andc-TEE and had higher patient tolerance.It was suggested that c-TCD or c-TTE examination could be given priority for suspected PFO patients,and TEE andc-TEE examination could be further performed for patients with positive examination results.