Diagnostic value of combined contrast-enhanced ultrasonography in right to left shunt of patent foramen ovale

Objective To explore the value of contrast-enhanced transcranial Doppler (cTCD) combined with contrast transthoracic echocardiography (cTTE) in the diagnosis and interventional treatment of patent foramen ovale (PFO).

Methods A total of 112 patients with highly suspected PFO admitted to the First Affiliated Hospital of Nanjing Medical University were recruited. All patients underwent cTCD, cTTE and transesophageal echocardiography(TEE)to evaluate the classification of right to left shunt (RLS) of PFO. Taking the results of transcatheter PFO exploration and occlusion as the'gold standard', the diagnostic efficacy of cTCD combined with cTTE and cTCD combined with TEE for diagnosis of PFO was compared.

Results The diagnostic sensitivity and accuracy of cTCD combined with cTEE were 98.1% and 93.8%, respectively, which were slightly higher than 96.2% and 91.1% of cTCD combined with TEE, but it showed no statistically significant difference (P>0.05). Among the 112 patients with highly suspected PFO, 106 cases (94.6%) received occlusion and were followed up for 6 to 12 months. No significant surgery-related complications or stroke recurrence were found in the patients, and 83.1% of the patients with migraines of varying degrees were relieved.

Conclusion The method of cTCD combined with cTT can accurately judge the source and severity of RLS with high sensitivity and accuracy. Therefore, it can be used in PFO screening.