Chest
Clinical Investigations: Cardiology and Cardiac SurgeryThe Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients: A Contrast Transesophageal Echocardiography Study
Section snippets
Study Population
We reviewed 1,000 consecutive nonsurgical TEEs that included 518 female subjects and 482 male subjects, with a mean age of 60 ± 17 years (range, 11 to 93 years). Patients were referred to the echocardiography laboratory from both hospital and outpatient settings. The most common clinical indications for the procedures included evaluation to rule out possible cardioembolic sources of stroke (including patients with TIA, stroke, peripheral emboli, atrial fibrillation, or other arrhythmias prior
Results
Patent foramen ovale was detected in 9.2% of all subjects (Table 2), with equal incidence in male and female subjects (9.54 vs 8.88%, respectively; p=not significant [NS]) The mean age of patients with PFO was 58.3 years compared with 60.6 years without PFO (p=NS). When the patients were separated by their age by decades, PFO was seen in all groups (Table 3). Because our patients were referred primarily by adult cardiologists, only 53 of our patients were younger than 30 years, in whom only
Discussion
Previous studies have implicated PFO as a possible cardioembolic source for cerebrovascular events.1, 2, 3,5, 8 To our knowledge, the current retrospective report is the largest study to examine each subject for the presence of PFO by both color Doppler and contrast TEE. Additionally, we evaluated 1,000 consecutive patients referred for TEE, not just those with suspected cardioembolic events. The incidence of PFO in this study was 9.2%, comparable with findings of other studies of normal
Conclusions
Our 9.2% incidence of PFO detected in all subjects was similar to findings in normal subjects in other studies,3, 9 but significantly lower than 27.3% incidence found in an autopsy study.4 Hausman et al18 demonstrated better detection of PFO with color and contrast TEE, and an increased prevalence of PFO in young patients with otherwise unexplained ischemic stroke. However, to our knowledge, our study of 1,000 patients represents the largest single report of the use of contrast TEE on a general
Recommendations
Transesophageal echocardiography with contrast may detect the cause from a cardioembolic source in patients with neurologic events. While PFO has been correlated with paradoxic emboli, one cannot assume the presence of PFO to be the culprit of all cryptogenic strokes. Currently, aspirin may be appropriate therapy for large-vessel atherosclerotic disease and for nonvalvular atrial fibrillation in patients younger than 75 years.19 However, anticoagulation with warfarin may be the preferred
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revision accepted November 7.