Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography

Luis Afonso, Anupama Kottam, Ashutosh Niraj, Joya Ganguly, Pawan Hari, Mengistu Simegn, Rajeev Sudhakar, Sony Jacob, Seemant Chaturvedi, Greg J. Ensing, Theodore P. Abraham

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.

Original languageEnglish (US)
Pages (from-to)1054-1058
Number of pages5
JournalAmerican Journal of Cardiology
Volume106
Issue number7
DOIs
StatePublished - Oct 1 2010
Externally publishedYes

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Patent Foramen Ovale
Transesophageal Echocardiography
Valsalva Maneuver
Aneurysm
Decompression Sickness
Hypovolemia
Injections
Atrial Pressure
Migraine Disorders
Cough
Fasting
Stroke
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography. / Afonso, Luis; Kottam, Anupama; Niraj, Ashutosh; Ganguly, Joya; Hari, Pawan; Simegn, Mengistu; Sudhakar, Rajeev; Jacob, Sony; Chaturvedi, Seemant; Ensing, Greg J.; Abraham, Theodore P.

In: American Journal of Cardiology, Vol. 106, No. 7, 01.10.2010, p. 1054-1058.

Research output: Contribution to journalArticle

Afonso, L, Kottam, A, Niraj, A, Ganguly, J, Hari, P, Simegn, M, Sudhakar, R, Jacob, S, Chaturvedi, S, Ensing, GJ & Abraham, TP 2010, 'Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography', American Journal of Cardiology, vol. 106, no. 7, pp. 1054-1058. https://doi.org/10.1016/j.amjcard.2010.05.037
Afonso, Luis ; Kottam, Anupama ; Niraj, Ashutosh ; Ganguly, Joya ; Hari, Pawan ; Simegn, Mengistu ; Sudhakar, Rajeev ; Jacob, Sony ; Chaturvedi, Seemant ; Ensing, Greg J. ; Abraham, Theodore P. / Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography. In: American Journal of Cardiology. 2010 ; Vol. 106, No. 7. pp. 1054-1058.
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AU - Ganguly, Joya

AU - Hari, Pawan

AU - Simegn, Mengistu

AU - Sudhakar, Rajeev

AU - Jacob, Sony

AU - Chaturvedi, Seemant

AU - Ensing, Greg J.

AU - Abraham, Theodore P.

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AB - Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.

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