NEW YORK (Reuters Health) – Standard echocardiography will confirm or exclude a patent foramen ovale (PFO) in most children, without the need for transesophageal echocardiography (TEE), clinicians from Texas have found.

Compared to TEE, standard echocardiography is less invasive and can be performed without sedation – and it’s also much less expensive.

In adults, however, TEE is the gold standard for diagnosing PFO. Transthoracic acoustic windows in adults often lead to poor-quality images and inconclusive test results, according to senior author Dr. Catherine Ikemba and colleagues from University of Texas Southwestern Medical Center, Dallas.

But as Dr. Ikemba and colleagues point out in Stroke online December 2nd, acoustic windows on transthoracic ultrasound are typically better in children than in adults. And now, Dr. Ikemba tells Reuters Health, her study has shown that a “transthoracic echocardiogram should be performed in pediatric patients when evaluating for an inter-atrial communication rather than the invasive transesophageal echocardiogram that is generally recommended in adults.”

The research team prospectively analyzed the results of transthoracic echocardiography with agitated saline injection for diagnosing PFO in 50 consecutive children referred for TEE. Imaging included 2-D color Doppler and agitated saline contrast injections, with actual or simulated Valsalva maneuvers. Standard echocardiography was done first, followed by TEE.

“Agitated saline contrast is an important component of this study, improving (the) detection rate by 50%,” Dr. Ikemba said.

The experienced readers who interpreted the standard studies were unaware of the TEE results. If transthoracic images didn’t allow for a definitive diagnosis the study was categorized as “inconclusive.”

On TEE, the prevalence of PFO was 20%. Seven transthoracic exams (14%) were inconclusive; of the remaining 43 exams, only one did not agree with the more invasive TEE.

The transthoracic exams had a positive predictive value of 100%, a negative predictive value of 97%, a sensitivity of 88% and a specificity of 100% for detecting PFO in this pediatric patient population.

Dr. Ikemba and colleagues say TTE with agitated saline “should be the first step in the evaluation of the atrial septum in pediatric patients. If the TTE is not conclusive, one should proceed to TEE. According to our study, greater than 85% of TEEs can be avoided.”

Reference:

Diagnosing a Patent Foramen Ovale in Children. Is Transesophageal Echocardiography Necessary?

Stroke 2010.