Additive Value of Transesophageal Echocardiography Without Sedation for Diagnosis of a High-Risk Patent Foramen Ovale

BACKGROUND AND OBJECTIVES: Recent studies have highlighted the validity of risk stratification based on using the concept of 'a high-risk patent foramen ovale (HRPFO)'. We sought to compare transesophageal contrast echocardiography (cTEE) without sedation and transthoracic contrast echocardiography (cTTE) for the diagnosis of HRPFO. METHODS: Clinical data from patients who underwent both cTTE and cTEE without sedation for the evaluation of cryptogenic stroke were retrospectively analyzed. HRPFO was defined as a patent foramen ovale (PFO) associated with an atrial septal aneurysm (ASA) or a hypermobile atrial septum, and a PFO with significant shunting (≥20 bubbles), or a PFO size (measured as the distance between the septum secundum and primum) of ≥2 mm. RESULTS: In 572 patients who underwent both cTTE and cTEE without sedation, the prevalence of PFO was 65.9% (377 patients), and 331 patients (57.9% of the total, 87.8% of those with PFOs) were diagnosed with HRPFO. A significantly higher prevalence of PFO (65.9% vs. 57.7%, p