Document Detail


Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography.
MedLine Citation:
PMID:  20854974     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.
Authors:
Luis Afonso; Anupama Kottam; Ashutosh Niraj; Joya Ganguly; Pawan Hari; Mengistu Simegn; Rajeev Sudhakar; Sony Jacob; Seemant Chaturvedi; Greg J Ensing; Theodore P Abraham
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Publication Detail:
Type:  Journal Article     Date:  2010-08-11
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-21     Completed Date:  2010-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1054-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Wayne State University, Detroit, Michigan, USA. lafonso@med.wayne.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Echocardiography, Transesophageal*
Female
Fluid Therapy*
Foramen Ovale, Patent / ultrasonography*
Humans
Infusions, Intravenous
Male
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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