Value of Contrast Transthoracic Echocardiography Combined with Transesophageal Echocardiography in Assessing Hypermobile Atrial Septum Complicated with Patent Foramen Ovale

LIU Zhao; WU Shasha; WANG Yufu; SUN Li; JIAO Ronghong

doi:10.3639/i.issn.2095-3097.2025.02.013

Abstract：Objective To investigate the diagnostic value of right-heart contrast transthoracic echocardiography(cTTE)combined with transesophageal echocardiography(TEE)in patients with hypermobile atrial septum complicated with patent foramen ovale(PFO).Methods A total of 88 patients with atrial septal oscillation detected by TEE in Hebei Provincial People's Hospital from September 2023 to February 2024 were retrospectively analyzed,and the length,direction and amplitude of atrial septal oscillation were recorded and measured.All patients were subjected to right heart acoustic imaging,and those who had a positive result were subjected to TEE to clarify whether there was a combination of PFO.The septal oscillation parameters of PFO patients were further analyzed to compare the diagnostic efficacy of single and combined diagnostic parameters of septal oscillation for PFO.Results Of the 88 patients with atrial septal oscillation,15(17.0％)were right-to-left shunt(RLS)-negative and 73(83.0％)were RLS-positive.The RLS grade was positively correlated with the amplitude of atrial septal oscillation toward the left atrial side,the amplitude of atrial septal oscillation toward the right atrial side,the sum of amplitude of atrial septal oscillation between the two atria,and the length of oscillation(P＜0.01).When the amplitude of oscillation toward the left atrial side was greater than 5.4(area under the curve[AUC]=0.674),the sensitivity of diagnosing PFO in patients with atrial septal oscillation was 55.0％,and the specificity 83.3％.When the oscillation amplitude toward the right atrial side was greater than 4.6(AUC=0.755),the sensitivity of diagnosing PFO in patients with septal oscillation was 66.7％,and the specificity was 83.3％.When the length of oscillation reached 14.2(AUC=0.719),the sensitivity of diagnosing PFO in patients with septal oscillation was 66.7％,and the specificity was 75.0％.When the bilateral oscillation was greater than 9.25(AUC=0.779),the sensitivity of diagnosing PFO in patients with septal swing was 76.7％,and the specificity was 91.7％.When using the combined diagnosis(AUC=0.901),the sensitivity for diagnosing PFO in patients with septal oscillations was 86.7％,and the specificity was 83.3％.The AUC,standard error(SE),and 95％ confidence interval(CI)of their combination in diagnosing PFO were significantly higher than those of the single index(amplitude of atrial septal oscillation toward the left atrial side,the amplitude of atrial septal oscillation toward the right atrial side,and the length of oscillation)(P＜0.05).However,the diagnostic efficacy of the combination in PFO was not superior to the sum of amplitude of atrial septal oscillation between the two atria(P=0.452).Conclusion There is a correlation between atrial septal oscillation and RLS,and related parameters of atrial septal oscillation are positively correlated with RLS grade.Any of the following parameters:amplitude of atrial septal oscillation toward the left atrial side≥5.4mm,the amplitude of atrial septal oscillation toward the right atrial side≥4.6mm,and the length of oscillation≥ 14.2mm,and sum of amplitude of atrial septal oscillation between the two atria≥9.2mm,has an increased diagnostic efficacy in PFO.A combination of cTTE and TEE has a significant value in diagnosing PFO in patients with hypermobile atrial septum.