Value of hand vibration and blood activated saline in the diagnosis of patent foramen ovale in right echocardiography by transesophageal echocardiography

CAO Jing; GUO Li-yan

doi:10.3969/j.issn.1672-5301.2024.06.012

Abstract：Objective To evaluate the value of hand vibration and blood activated saline(ASB)in the diagnosis of patent foramina ovale(PFO)in right heart echocardiography(TEE-cTTE).Methods A total of 106 patients with suspected PFO in Linfen People's Hospital from July 2020 to January 2023 were selected and divided into the PFO group(78 cases)and non-PFO group(28 cases)according to relevant diagnostic criteria.All the patients underwent TEE-cTTE examination and were divided into ASB,hand-activated 50％glucose solution(AGS)and hand-activated saline(AS)according to the type of contrast agent.The time from the start of right heart imaging to the gradual decrease of microbubbles to less than 10 microbubbles per frame image(T-R),the diameter and the length of the foramen ovale tunnel in both groups were compared for the three contrast agents.The diagnostic value of TEE-cTTE examination with three contrast agents for PFO,PFO type and right-to-left shunt(RLS)was analyzed.Results T-R was longer in ASB resting state and Valsalva movement than in AGS and AS;T-R was longer in AGS resting state and Valsalva movement than in AS(P＜0.05).The diameter of foramen ovale in PFO group was larger than that in non-PFO group(P＜0.05).The diameter of foramen ovale in PFO group measured by ASB and AGS was larger than that measured by AS(P＜0.05).ROC curve analysis showed that the AUC of TEE-cTTE diagnosis of PFO in ASB was 0.872(95％CI:0.793～0.929),the sensitivity was 92.31％(72/78)and the specificity was 82.14％(23/28);the AUC in AGS for the diagnosis of PFO by TEE-cTTE was 0.842(95％CI:0.758～0.905),the sensitivity was 89.74％(70/78)and the specificity was 78.57％(22/28);the AUC in AS for the diagnosis of PFO by TEE-cTTEAUC was 0.672(95％CI:0.574～0.760),the sensitivity was 80.77％(63/78)and the specificity was 53.57％(15/28).It suggesting that ASB and AGS were better than AS in diagnosing PFO.The type of PFO and RLS grade diagnosed by TEE-cTTE on ASB were consistent with the clinical diagnosis results(Kapp value=0.819,0.838).The type of PFO and RLS grade diagnosed by TEE-cTTE examination in AGS were generally consistent with the clinical diagnosis results(Kapp value=0.653,0.655).The consistency between PFO type diagnosed by TEE-cTTE in AS and the clinical diagnosis results was poorer(Kapp value=0.393),and the consistency between the diagnostic RLS grade and the clinical diagnosis results was general(Kapp value=0.480).Conclusion The application of ASB imaging in TEE-cTTE examination can prolong T-R time,improve the diagnostic value for PFO and show a high consistency with clinical diagnosis results in the diagnosis of PFO types and RLS classification,which is conducive to carrying out targeted and scientific clinical diagnosis and treatment.