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CLINICAL RESEARCH: CARDIAC IMAGING

Cardiac Magnetic Resonance Imaging and Transesophageal Echocardiography in Patients With Transcatheter Closure of Patent Foramen Ovale

Department of Internal Medicine II–Cardiology, University of Ulm, Ulm, Germany.

Manuscript received October 11, 2005; revised manuscript received March 1, 2006, accepted March 28, 2006.

^_* Reprint requests and correspondence: Dr. Vinzenz Hombach, Department of Internal Medicine II–Cardiology, University of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany. (Email: vinzenz.hombach{at}uniklinik-ulm.de).

OBJECTIVES: We studied the value of cardiac magnetic resonance imaging (CMRI) before and after closure of patent foramen ovale (PFO) in patients with cryptogenic ischemic events.

BACKGROUND: Cardiac magnetic resonance imaging is a powerful noninvasive tool for detailed assessment of cardiac anatomy and function. The relevance of CMRI compared with transesophageal echocardiography (TEE) in patients undergoing transcatheter PFO closure has not been evaluated so far.

METHODS: Contrast-enhanced CMRI and TEE were performed in 75 patients before and after PFO closure. Twelve months after PFO closure, both imaging techniques were repeated in 61 patients with contrast application. To determine provokable atrial right-to-left shunting in CMRI, we applied a contrast-enhanced perfusion imaging technique. Detection of atrial septal aneurysm (ASA) was achieved by means of a high-resolution cine imaging technique.

RESULTS: Before PFO closure, ASA was seen with CMRI in 28 of 75 cases (37.3%), compared with 47 of 75 (62.7%) cases using TEE. There were a total of 211 CMRI studies with a corresponding TEE performed in 75 patients. No shunt was present in 107 of 211 studies with both techniques. Contrast-enhanced right-to-left shunting was detected by CMRI in 48 of 72 (66.6%) cases with moderate or severe shunts seen with TEE, but only in 6 of 32 (18.8%) studies with mild shunts with TEE. Anomalous venous returns were excluded in all patients. In two patients, coronary anomalies were seen.

CONCLUSIONS: The present CMRI technique is inferior to TEE in detection of contrast-enhanced right-to-left shunting and identification of ASA.

Abbreviations and Acronyms   ASA = atrial septal aneurysm   CMRI = cardiac magnetic resonance imaging   Gd-DTPA = gadolinium-diethylenetriaminepentaacetate   PFO = patent foramen ovale   SSFP = steady-state free precession   TEE = transesophageal echocardiography

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