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document
Femoral vein delivery of contrast medium enhances transthoracic echocardiographic detection of patent foramen ovale . OBJECTIVES We postulated that femoral vein delivery of contrast medium because of streaming , might enhance precordial echocardiographic detection of patent foramen ovale . BACKGROUND Although precordial contrast echocardiography is widely used to diagnose patent foramen ovale , this method is limited by poor sensitivity . Previous investigators have demonstrated enhanced detection of atrial defects by the dye-dilution technique after delivery of contrast medium into the inferior rather than the superior vena cava . METHODS Transthoracic contrast examinations were performed in a randomly selected group of 70 patients ( without previous history of cerebral or systemic embolus ) undergoing cardiac catheterization . Paired contrast agent injections ( 10 ml dextrose in water/0.25 ml air ) were administered from an upper extremity vein and femoral vein in each patient during spontaneous respiration , cough and Valsalva maneuvers . Studies were interpreted by an experienced echocardiographer unaware of the sequence and site of injections . Positive studies were semiquantitatively graded from +1 ( minimal left ventricular opacification ) to +4 ( intense left ventricular opacification ) . Catheterization and echocardiographic assessment of patent foramen ovale were compared in 21 subjects . RESULTS Patent foramen ovale was detected significantly more often during femoral vein versus upper extremity contrast delivery ( 23 of 70 patients [ prevalence 33 % ] vs. 9 of 70 patients [ prevalence 13 % ] , p < 0.001 ) . The intensity of left ventricular opacification was also greater during femoral vein contrast injection . Precordial echocardiography combined with femoral contrast delivery was significantly more sensitive than cardiac catheterization for assessment of patent foramen ovale ( 8 of 21 patients vs. 2 of 21 patients , p < 0.05 ) . CONCLUSIONS Femoral vein contrast delivery significantly enhances the ability of precordial contrast echocardiography to diagnose patent foramen ovale . Physiologic patency of the foramen ovale is more common ( prevalence 33 % ) than previously documented .
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Intervention_Physical
Transthoracic contrast examinations
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Intervention_Pharmacological
contrast agent injections ( 10 ml dextrose in water/0.25 ml air )
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Intervention_Physical
Femoral vein contrast delivery
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Outcome_Other
transthoracic echocardiographic detection
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Outcome_Physical
patent foramen ovale
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Outcome_Other
precordial echocardiographic detection
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Outcome_Physical
atrial defects
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Outcome_Other
Catheterization
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Outcome_Physical
and
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Outcome_Other
echocardiographic assessment
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Outcome_Physical
of patent foramen ovale
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Outcome_Other
intensity of left ventricular opacification
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Outcome_Physical
sensitive
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Outcome_Physical
assessment of patent foramen ovale
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Outcome_Other
ability of precordial contrast echocardiography to diagnose patent foramen ovale .