조영 경식도 심초음파에 의한 난원공개존 유병율 및 임상적 의의 = Frequency of Patent Foramen Ovale and Its Clinical Significance

다국어 초록 (Multilingual Abstract)

Objectives: Most of patients with patent formen ovale have normal intracardiac pressure and no other abnormality during their life. But because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may occur. Although this is a rare complication, the result can be devastating. Previously, contrast transthoracic echocardiography was used to demonstrate patent foramen ovale but the prevalence rate was less than the expected one based on autopsy in general population. These low detection rates have discouraged the use of contrast transthoracic echocardiography to diagnose patent foramen ovale. But transesophageal echocardiography provides larger tomographic field and more clear views around the interatrial septum than transthoracic echocardiography, We tried this study to evaluate the incidence of patent foramen ovale and its role as a possible cause of paradoxical embolism in cerebral infarction patients. Methods: Contrast transesophageal echocardiographic examinations with indocyanine green were performed in 426 patients including 32 patients with cerebral infarction. The prescence of the patent forancen ovale was confirmed by demonstrating echogenic contrast crossing the interatrial septum. Result: 1) Contrast transesophageal echocardiography is a useful technique to evalute right to left shunt, 2) Patent foramen ovale was demonstrated in 73 of 426 patients and 6 of 32 two patients with cerebral infarction showed pakent formen ovale. But patent formen ovale was thought to be a cause of paradoxical embolism only in 3 patients without accompanying cardiovascular disease or risk factors. 3) The prevalence of patent foramen ovale increased progressively with increasing age. 4) There are no serious complications during and after contrast transesophageal echocardiography. Conclussion: Contrast transesophageal echocardiography is a safe, and reliable technique for evaluating interatrial shunt provoked with cough or Valsalva maneuver. This technique should be considered in cerebrovascualr disease patients without known risk factors to evaluate the possible paradoxical embolism.