Abstract 5796: Real-Time 3D Transesophageal Echo Enhances the Diagnostic Capabilities of Patent Foramen Ovale in Patient’s with Cerebral Vascular Accidents
Real-time 3D transesophageal echo (RT3D TEE) is a novel technology whereby RT3D rendering of ultrasound images is performed resulting in unique views of cardiac structures. We have presented initial data reporting the incidence of optimal en face visualization of cardiac structures including the fossa ovalis (FO). We aimed to further characterize the FO. Therefore, our hypotheses were that the FO could be seen en face in full circumferential view (CV) in most patients and saline contrast RT3D TEE would enhance the accuracy of patent foramen ovale (PFO) diagnosis compared to contrast 2D TEE. Therefore, in an unselected series of 124 patients referred for TEE, we performed RT3D TEE with specific views of the FO using the Philips x7–2t RT3D TEE transducer. Images of the FO were acquired in the real-time 3D, 3D zoom, and full volume modes. Visualization of the FO was scored by 2 separate observers using the following scale:
full CV of the FO
The visualization score was 1.44. The average maximal and minimal diameters of the FO during the cardiac cycle were 1.46±0.90 and 1.12±0.12cm and an average maximum area of 169±20mm2. The sensitivity of saline contrast RT3DTEE for PFO diagnosis was 100% with specificity of 96% due to 3 cases where PFO was seen only by RT3D TEE.
RT3DTEE allows complete circumferential visualization of the FO in the majority of cases.
Our determination of the size of the FO compares favorably with pathologic series
Some cases of PFO can be expected to be detected only by RT3DTEE and therefore this technique should be performed when 2D TEE is negative for PFO but clinical suspicion remains high.