Analysis of fossa ovalis membrane velocities by transesophageal Doppler tissue echocardiography: A novel approach to functional assessment of patent foramen ovale

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Background

Recent studies have suggested that a higher mobility of the fossa ovalis membrane (FOM) may be associated with an increased risk for stroke in patients with patent foramen ovale (PFO). The current study analyzed whether Doppler tissue echocardiography is useful for quantitation of FOM motion velocities.

Methods

FOM dynamics were prospectively studied in 107 consecutive patients (average age 50.7 ± 15.3 years, 48 men) with in sinus rhythm who underwent transesophageal echocardiography for various indications. With pulsed wave Doppler tissue echocardiography interrogation, a characteristic quadrophasic signal was recorded in all patients, consisting of a positive wave toward the left atrium (A-wave) at late diastole, followed by a negative wave (B-wave) toward the right atrium, a pronounced, again positive wave during midsystole (C-wave), and a final negative wave (D-wave).

Results

Peak velocities of A-wave, B-wave, C-wave, and D-wave were 0.08 ± 0.02 m/s, 0.11 ± 0.05 m/s, 0.17 ± 0.07 m/s, and 0.14 ± 0.06 m/s, respectively. In 21 of 107 (19.6%) patients, PFO was detected. Patients with PFO had significantly higher C-wave and D-wave peak velocities compared with the 86 patients without PFO (0.23 ± 0.10 m/s vs 0.15 ± 0.05 m/s, P < .001 and 0.16 ± 0.07 m/s vs 0.12 ± 0.06 m/s, P = .04, respectively).

Conclusions

Assessment of FOM dynamics using Doppler tissue echocardiography is feasible. It allows definition of a characteristic quadrophasic FOM motion pattern, thereby providing new insights into the physiology of FOM mobility. Patients with PFO were found to have increased FOM mobility compared with patients without PFO.

Section snippets

Patient population

A total of 107 consecutive patients with in sinus rhythm who underwent TEE for various indications were prospectively studied. Patients with atrial septal defects and left-to-right shunting were excluded. Indications for TEE were: detection of cardiac source of embolism (n = 39); evaluation of valvular disease (n = 33); suggested endocarditis (n = 25); evaluation of aortic disease (n = 5); evaluation of intracardiac masses (n = 2); and evaluation of left ventricular (LV) function as a result of

Results

TEE was successfully completed in all 107 patients without premature interruptions, and no complications occurred. Patient's characteristics and TEE results are summarized in Table 1. In 21 of 107 (19.6%) patients PFO was detected (group 1). The remaining 86 patients served as a control group (group 2).

Discussion

To our knowledge, this is the first study to assess physiologic FOM dynamics using DTE. Our results demonstrate that evaluation of FOM dynamics using DTE is feasible. Pulsed wave DTE interrogation is particularly useful for quantitation of FOM dynamics. Besides a reproducible quadrophasic FOM motion pattern, which was observed in all patients, characteristic changes were found in patients with PFO. In addition, our study presents the normal values of FOM motion in patients with and without PFO,

References (19)

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Dr Eggebrecht is recipient of a research grant from the University Duisburg-Essen (IFORES 10+2).

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