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Abstract
This study compares the value of transthoracic (TTE) and transesophageal (TEE) color
Doppler and contrast echocardiography for detecting a patent foramen ovale (PFO).
A total of 238 patients were studied: 74 patients with a history of otherwise unexplained
ischemic stroke, transient cerebral ischemic attacks or peripheral embolic events
(group A), 48 with a history of similar episodes explained by other cardiac abnormalities
(group B), and 116 with no embolic events (group C). A PFO was detected by contrast
TEE in 50 of 238 patients (21%) compared with 45 patients (19%) by color Doppler TTE.
In a subgroup of 198 patients, TEE results could be compared with TTE findings. No
patient had a PFO identified by color Doppler TTE. Contrast TTE detected a PFO in
15 patients (8%) compared with contrast TEE which demonstrated a PFO in 44 of 198
patients (22%) (p less than 0.001). Prevalence of PFO by TEE was 22, 21 and 22% in
groups A, B and C, respectively. A PFO was present in 50% of patients aged less than
40 years and otherwise unexplained ischemic stroke; this percentage was higher (p
less than 0.05) than corresponding values found in all other groups. Thus, contrast
and color Doppler TEE are significantly superior to TTE for detecting PFO. The prevalence
of PFO is significantly increased in young adults with otherwise unexplained ischemic
stroke.