Diagnosing a Patent Foramen Ovale in Children Is Transesophageal Echocardiography Necessary?

Background and Purpose—Transesophageal echocardiography (TEE) is the gold standard for the diagnosis of a patent foramen ovale in adults. In children, acoustic windows on transthoracic echocardiography (TTE) are better than in adults; thus, an invasive TEE may not be necessary. Our goal was to assess the validity of TTE with agitated saline injection for the diagnosis of a patent foramen ovale in children using TEE as the gold standard. Methods—Fifty consecutive pediatric patients 1 year of age referred for TEE were prospectively enrolled. Imaging included 2-dimensional, color Doppler, and agitated saline contrast injections with and without Valsalva by TTE followed by TEE. Interpreters of the TTE were blinded to TEE results. Studies were categorized as “inconclusive ” if the TTE images were inadequate for definitive diagnosis by the blinded interpreter. Results—TTE results were considered conclusive in 43 of 50 (86%) patients. Among the 43 conclusive studies, the 2 modalities disagreed in 1 patient. TTE had a positive predictive value of 100%, negative predictive value 97%, sensitivity of 88%, and specificity of 100 % for detecting a patent foramen ovale. Conclusions—TTE with agitated saline injection is diagnostic for the assessment of atrial septal integrity in the majority of children. (Stroke. 2011;42:98-101.) Key Words: contrast echocardiography foramen ovale patent pediatrics A probe patent foramen ovale (PFO), often considered anormal variant, is present in at least 1 in 4 patients o