THE INCIDENCE OF PATENT FORAMEN OVALE IN 1,000 CONSECUTIVE PATIENTS -A CONTRAST TRANSESOPHAGEAL ECHOCARDIOGRAPHY STUDY

Study objective: Patent foramen ovale (PFO) is present in 10 to 35% of people and has been reported to be an important risk factor for cardi oembolic cerebrovascular accidents (CVAs) and transient ischemic attac ks (TIAs), especially in younger patients. While contrast transthoraci c echocardiography has been used to detect PFO, contrast transesophage al echocardiography (TEE) has a greater sensitivity. Prior studies rep orted the incidence of PFO in patients presenting with a CVA or TIA. D esign: To determine the incidence of PFO in a more general population, we reviewed 1,000 consecutive TEEs performed with contrast and color Doppler for the presence of PFO and other cardioembolic risk factors, including atrial septal aneurysm (ASA), aortic plaque, atrial fibrilla tion (AFib), and atrial thrombi. While imaging with monoplane or bipla ne TEE, multiple injections of agitated saline solution were injected during cough or Valsalva maneuver to detect now through a PFO. Patient s: There were 482 male and 518 female patients with mean age of 60 +/- 17 years (range 11 to 93 years). Results: Patent foramen ovale was fo und in 9.2% of all patients and, though seen in all age groups divided by decade, the incidence in patients aged 40 to 49 years was greater than those aged 70 to 79 years (12.96% vs 6.15%, p=0.03). Contrast TEE had a much higher detection rate than color Doppler alone. Importantl y, there was no greater incidence of PFO in patients with CVA vs those without CVA, or in male vs female patients. Also, there was a very st rong correlation between the presence of ASA and PFO (p<.001). Conclus ion: Thus, PFO detected by TEE, frequently seen with ASA, is seen in a ll age groups and does not in itself present a risk factor for CVA. Th e association of PFO with peripheral thrombosis and CVA needs further study.