Background

Patent foramen ovale has been suggested as a major cause of cryptogenic strokes and transient ischemic attack. Two-dimensional transesophageal echocardiography (2D TEE) with agitated saline contrast is currently the gold standard to diagnose PFO. Valsalva maneuver which is often used to improve the detection of PFOs may be difficult to perform in the sedated patients during TEE. The advent of a real-time 3-dimensional transesophageal echocardiography (3D TEE) allowed direct visualization of the entire fossa ovalis and surrounding structures. In this trial we evaluated the morphologies of PFO with real-time three-dimensional transesophageal echocardiography and defined the morphologic features to decide the optimum device type in PFO closure.

Methods

We retrospectively evaluated 32 patients with 2D and 3D TEE who have admitted to cardiology department with recurrent transient ischemic attack(TIA) or cryptogenic stroke. Inclusion criteria for PFO closure included the following;

• 1)
  

  Concurrent shunt pattern on transcranial doppler,

  
  
• 2)
  

  Positive cerebral magnetic resonance imaging for previous embolic events,

  
  
• 3)
  

  Previous history of TIA and stroke,

  
  
• 4)
  

  Moderate or large size PFO on transesophageal echocardiography.

The size and rim length, rim thickness were also measured.