Assessing patent foramen ovale on coronary computed tomographic angiography: a comparison with transesophageal echocardiography

Purpose This study was undertaken to determine if coronary computed tomographic angiography (CCTA) can help to assess patent foramen ovale (PFO) with high accuracy and reproducibility when compared to transesophageal echocardiography (TEE). Materials and methods In total, 75 suspected PFO cases (31 men, 44 women; mean age, 45 +/- 9 years) were evaluated by coronary CTA and TEE. PFO tunnel length (TL) and the opening diameter of the left atrial entrance (ODLAE) and right atrial entrance (ODRAE), as well as contrast shunt (if present due to PFO), were measured by both modalities. Results PFO was detected in 68 patients with TEE. The sensitivity for the detection of PFO with CCTA was 85.3%; specificity, 71.4%; positive predictive value, 96.7%; and negative predictive value, 33.3%. Both modalities demonstrated good agreement in measuring TL and ODLAE of PFO. However, the ODRAE of TEE was different from that of CCTA (1.14 +/- 0.4 mm and 1.45 +/- 0.5 mm, respectively, p = 0.04). The intra-observer and inter-observer variability and agreement for TL, ODRAE, and ODLAE of PFO were excellent between the two measurements. Conclusion CCTA provided a method for detection of PFO with high accuracy and reproducibility compared with TEE. Therefore, CCTA is a practical and efficient alternative to TEE for PFO diagnosis.

Automated summary

This study demonstrates that coronary computed tomographic angiography (CCTA) has high accuracy and reproducibility in assessing patent foramen ovale (PFO) compared to transesophageal echocardiography (TEE). CCTA could be a practical and efficient alternative to TEE for PFO diagnosis.