Akademik Veri Yönetim Sistemi
European Society of Cardiology Congress 2020, Amsterdam, Hollanda, 29 Ağustos - 01 Eylül 2020, cilt.41, sa.946, ss.2430, (Özet Bildiri)
Background: Patent foramen ovale (PFO) is one of the causes of cardioembolism
and closure of PFO is recommended by the current guidelines
in patients with recurrent stroke. Transoesophageal echocardiography
(TEE) using bubble-contrast study is the gold standard imaging modality for
the assessment of interatrial septum. Upper-extremity veins are the most
common way of injection, however, the presence of Eustachian valve and
flow dynamics when bubble-contrast injection performed via upper extremity
veins limits the assessment of interatrial septum in several cases. In this
study, we aimed to compare the efficacy of bubble-contrast study between
upper extremity injection and lower extremity injection.
Material/Methods: Patients with a suspicion of cardioembolism who were
undergoing TEE study were included in this study. After routine assessment
of cardiac structures, the bubble-contrast study was performed using
agitated saline from both upper-extremity vein and lower-extremity vein
with Valsalva manoeuvre. Right-to-left shunt and numbers of bubbles transmitted
from the septum were recorded.
Results: We prospectively included 45 patients and 21 PFOs were detected.
There were 9 patients with prominent Eustachian valve and in 6
patients Eustachian valve hampered the complete opacification of the right
atrium. In 3 patients flow from the superior vena cava was directed towards
the tricuspid valve and hampered the complete opacification. Among
21 patients with PFO, in 6 patients right-to-left shunt was not observed
when agitated-saline was injected via the upper-extremity vein, however,
the shunt was observed when the agitated-saline was injected via the
lower-extremity vein. In 14 patients amount of bubbles passing through
the interatrial septum were significantly higher when the injection was performed
via the lower-extremity vein especially in patients with prominent
Eustachian valve.
Conclusion: Our preliminary results indicated that compared to upperextremity
veins, injection via the lower-extremity veins provides better
opacification of right atrial septum and assessment of interatrial septum.
Therefore, injection through the lower-extremity veins would be the preferred
choice particularly in patients with prominent Eustachian valve or
downward directed flow from the superior vena cava.