DIAGNOSIS OF PATENT FORAMEN OVALE BY CONTRAST VERSUS COLOR DOPPLER BYTRANSESOPHAGEAL ECHOCARDIOGRAPHY - RELATION TO ATRIAL SIZE

To ascertain the factors related to the transesophageal echocardiograp hic diagnosis of patent foramen ovale, the primary echocardiographic d ata were reviewed from 74 patients with that diagnosis. Similar detect ion rates were observed with contrast echocardiography (82%) and color flow mapping (78%), but contrast was more sensitive in patients with normal-sized atria (94%) and isolated right atrial enlargement (100%) than in those with enlarged left atria, all but three of whom had biat rial enlargement (52%) (p < 0.001 by chi-square test). Doppler flow ma pping was less sensitive for normal-sized atria (66%) than for isolate d enlarged right atria (81%) and left (bi-) atrial enlargement (96%) ( p = 0.024). Patent foramen ovale was directly visualized by two-dimens ional echocardiography in 80%, with close agreement to the size of the color Row jet (r = 0.90, Delta = 0.1 +/- 0.4 mm); foramen ovale size was related to right atrial area (r = 0.31, p = 0.015). Thus both sali ne contrast and color flow imaging are necessary to exclude the diagno sis of patent foramen ovale.