Dc. Fisher et al., THE INCIDENCE OF PATENT FORAMEN OVALE IN 1,000 CONSECUTIVE PATIENTS -A CONTRAST TRANSESOPHAGEAL ECHOCARDIOGRAPHY STUDY, Chest, 107(6), 1995, pp. 1504-1509
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.