Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients

doi:10.1016/j.euje.2005.04.007

European Journal of Echocardiography 2006 7(2):147-154; doi:10.1016/j.euje.2005.04.007

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Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients

Geraud Souteyrand^a^,*, Pascal Motreff^a, Jean-René Lusson^a, Raphaël Rodriguez^a, Etienne Geoffroy^a, Claire Dauphin^a, Jean-Yves Boire^b, Dominique Lamaison^a and Jean Cassagnes^a

^aDepartment of Medicine and Cardiology, Hospital Clermont Ferrand, Rue Montalembert, 63000 Clermont Ferrand, France
^bDepartment of Biostatistics, Hospital Clermont Ferrand, Rue Montalembert, 63000 Clermont Ferrand, France

Received 14 January 2005; received in revised form 22 April 2005; accepted after revision 27 April 2005.

^* Corresponding author. Tel.: +33 514 725 9246. gacsouteyrand{at}sympatico.ca

Abstract

Aims The comparison of three imaging methods to determine whichis the most accurate and reliable for the detection of right-to-leftshunt.

Methods and results One hundred and seven patients who werehospitalized for stroke underwent: a transthoracic echocardiography(TTE) using second harmonic, a transcranial Doppler (TCD) anda transesophageal echocardiography (TEE) from August 2003 toApril 2004.

All studies were recorded on a videotape and were studied bya physician blinded to the study.

With TTE and TEE, we found 44 (41%) patent foramen ovales. Allcontrast tests were positive with TCD for these 44 patients.

For two patients, the contrast test was positive only with TTEand TCD. We found four false negative contrast tests with TTE.

Among the 63 patients who had a negative contrast test withTEE and TTE, the results were the same with TCD for 59 of them;we were not able to determine a cause for the four positivetests.

Conclusion This study confirms that transesophageal echocardiographyhas limitations in the diagnosis of patent foramen ovale.

In this study, the negative predictive value of transcranialDoppler was excellent. Therefore, this examination is able toexclude a patent foramen ovale with a high level of confidence.

Keywords: Patent foramen ovale; Transthoracic echocardiography; Transcranial Doppler; Transesophageal echocardiography

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