Diagnostic Value Of CTCD,cTTE And CTEE In Right To Left Shunt Of Patent Foramen Ovale

Objective:To evaluate the diagnostic value of contrast transcranial doppler(cTCD),contrast transthoracic echocardiography(cTTE)and contrast transesophageal echocardiography(cTEE)in right to left shunt(RLS)of patent foramen ovale(PFO).Methods:41 patients with stroke of unknown cause or migraine who were diagnosed as PFO were retrospectively selected from our hospital from November 2018 to August 2021,and the image data of cTCD,cTTE and cTEE were analyzed and compared.Results:Among the 41 patients,the detection rate of PFO-RLS by cTCD was higher than that by cTTE(P<0.05).There was no significant difference in the detection rate of PFO-RLS between cTEE and cTTE(P>0.05).After valsalva maneuver(VM),the detection rate of PFO by cTCD、cTTE and cTEE was higher than that in calm state(P<0.05).cTCD and cTTE showed no significant difference in semi-quantitative grading results(P>0.05).The semi quantitative shunt grades of cTCD and cTTE were higher than cTEE(P<0.05).In the semi quantitative classification of cTCD and cTTE,the diameter of the right atrial opening of PFO was positively correlated with the grade of PFO-RLS(P<0.01).The left atrial opening diameter of PFO was positively correlated with PFO-RLS grade(P<0.01).There was no significant correlation between PFO length and shunt grade(P>0.05).Conclusion:cTCD has high sensitivity,but cannot distinguish the source of RLS,so it can only be used as a screening method for PFO-RLS.cTTE can distinguish the source of RLS and evaluate the grade of PFO-RLS,but it is easy to overestimate the grade of PFO-RLS when combined with intrapulmonary RLS.Although cTEE is a semi-traumatic examination,it can clearly observe the anatomical structure of PFO to provide information for subsequent interventional surgery and exclude intrapulmonary RLS,so as to avoid overestimation of PFO-RLS grade.The grade of PFO-RLS was positively correlated with the diameter of right atrial and left atrial openings,but not with the length of PFO.