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CLINICAL STUDY: NEW METHODS

Transmitral Doppler: a new transthoracic contrast method for patent foramen ovale detection and quantification

^a Cardiac Ultrasound Laboratory, Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
^b Harvard Medical School, Boston, Massachusetts, USA

Manuscript received December 13, 1999; revised manuscript received May 8, 2000, accepted June 28, 2000.

Reprint requests and correspondence: Dr. Michael Picard, VBK508, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114
MHPICARD{at}PARTNERS.ORG

OBJECTIVES

This study compared a new transthoracic echocardiographic (TTE) method for detection of right to left bubble passage, transmitral Doppler (TMD), against two-dimensional (2D) TTE contrast study and the gold standard, of transesophageal echocardiography (TEE), and assessed its utility in quantitative assessment of patent foramen ovales (PFO).

BACKGROUND

Current TTE methods are relatively insensitive in PFO detection and do not allow quantitative assessment of right to left shunt.

METHODS

In 44 patients (59 years, range 34 to 76 years) saline contrast and color Doppler studies were performed in three conditions—TTE TMD, TTE 2D and TEE. Bubble transit on the TMD was measured semiquantitatively by a visual bubble score and objectively by integrating the acoustic power within the mitral velocity envelope.

RESULTS

By TEE it was determined that 17 patients (39%) had PFOs; 16 had right to left contrast passage, and only 1 had left to right flow by color Doppler. Against TEE contrast study, the sensitivity of TMD and 2D contrast studies were 100% and 75%, respectively, with specificity of 96% and 100%. Greater than 10 bubbles on a single beat of the resting contrast TMD identified patients with a maximum resting TEE PFO opening diameter >2 mm with 78% sensitivity and 100% specificity. There was a strong correlation (r² = 0.72, p < 0.01) between the TMD acoustic power and PFO opening diameter.

CONCLUSIONS

Transmitral Doppler is a sensitive and specific method for TTE PFO detection that allows quantification of right to left bubble passage and may obviate the need for TEE in many patients after stroke.

Abbreviations and Acronyms   LA = left atrium or atrial   PFO = patent foramen ovale   PTI = power-time integral   RA = right atrium or atrial   TCD = transcranial Doppler   TEE = transesophageal echocardiography   TMD = transmitral Doppler   TTE = transthoracic echocardiography   2D = two-dimensional

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